Wufoo

Media & Class Projects Interview Request Form

Thank you for contacting us and for thinking of the Counseling Center as a resource to you! We take great pride in working with all members of the campus toward increasing the emotional well-being of the KSC community and providing our expertise for media interviews and class assignments in the area of mental health.

If you'd like to speak with one of our clinical staff for your emotional health topic, please fill out the request form below. This form will help us learn more about your needs and identify a specific staff member to assist with your article, paper, or project. To allow for thoughtful planning and staff scheduling, be sure to make your request at least 1 week in advance of your deadline date.

Emotional Health Topic *
What would you like to learn/experience: *
Due Date: * MM / DD / YYYY
Are you looking to speak with a specific staff member (if so, list staff member name)?
Reason for request: *

Please note if this is for a class paper, Equinox article, etc.
Additional Comments:
Please Note: The Counseling Center will attempt to supply a staff member to meet your request. However, we cannot guarantee that we will be available for every request as this depends on staff expertise and the volume of requests.
Contact Person
Affiliation *
Other explanation:
Contact Name * First Last
Phone Number * ### - ### - ####
Email *
Do Not Fill This Out

Wufoo

Please Note: The Counseling Center will attempt to supply a staff member to meet your request. However, we cannot guarantee that we will be available for every request as this depends on staff expertise and the volume of requests.

Contact Person