Help Form

Please complete the form below. Required fields marked with an asterisk * (If this is an emergency, please dial 911. If this form is submitted outside the hours of 7 a.m. - 4 p.m., Monday-Friday, you will be contacted on the next scheduled work day. The information on this form will be kept confidential except in cases involving threat or harm to yourself or others.)

Are you an adult or high school student?*

Answer required for "Are you an adult or high school student?"

Adult

What campus do you attend? *

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Shawnee

Seminole

Aviation

What program do you attend?*

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Do you attend in the morning or afternoon?*

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What type of help are looking for?*

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Mental Health/Personal

Academic

Other:

Contact Information

First Name*

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Last Name*

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Gordon Cooper Email Address*

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Phone Number*

Number Required

What is you preferred method of contact?*

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Gordon Cooper Email Address

Phone

Please fix the highlighted areas below before submitting.

Help Form