Help Form

Please complete the form below. Required fields marked with an asterisk * (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?*

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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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Email*

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Phone*

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What is you preferred method of contact?*

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Phone

Please fix the highlighted areas below before submitting.

Help Form