Request for Assistance

This form may be used to request assistance from the Office of Student Services. Requests may be submitted by students for themselves, or by a faculty member who believes a student may benefit from support. Once the request is submitted, a representative of the Office of Student Services will follow up with you within 1-2 business days.

If this is an urgent matter, needing immediate assistance, do not use this form. Please contact to the UF Counseling and Wellness Center's Crisis Support line at (352) 392-1575. Crisis counselors are available 24/7 to assess needs while providing information on available resources. More information on the UF Counseling and Wellness Center's Crisis Support options are available from the UFCWCs website here: UF Counceling and Wellness Center

"*" indicates required fields

Name*

Your name.

First Last

Email Address

Your email.

Preferred Phone Number*

Your preferred phone number.

College of Nursing Role*

Name of Student Needing Assitance*

For CON faculty use only.

First Last

Academic Program/Track*

Type of Assistance Being Requested

Please choose a type of assistance being requested.

Is student aware of referral?

For CON faculty use only.

Name

This field is for validation purposes and should be left unchanged.