Please note: For fall 2022, the Student Counseling Center is requesting that students wear masks for in-person sessions. If a student prefers not to mask, a virtual session can be scheduled.
(Copy and paste the list below into your email and provide an answer to each)
Full Name:
Preferred Name:
Student ID:
Preferred Pronouns:
Phone Number:
Is it OK for us to text reminders to this number? (Y or N)
Date of Birth:
MICA Email:
Is it OK for us to email reminders to this email address? (Y or N)
Campus or Local Address (with room no. for a dorm or apt. no. for off-campus, if in bldg):
Local/On-Campus Emergency Contact (Name and Number):
Days and Times Available (for all 5 days Mon.-Fri.):
Remember, only the student who will be requesting counseling services should take the first-step of scheduling an appointment.