Conflict Resolution Intake Form | Student Resolution Center

This form is only for those who already have an appointment scheduled.

If you'd like to be scheduled for an appointment, please fill out the following form: https://resolutioncenter.colostate.edu/request-an-appointment/

CR Intake Form

1. Name*

First Last

Preferred Name

Pronouns

CSU ID #*

Email*

Phone*

What best describes your role at CSU?*

Student
Faculty/Instructor
Staff
Other

[For students:] What year are you in school?

First Year
Sophmore
Junior
Senior
Graduate Student

Are you a part-time student (less than 12 credits)?

Yes
No

Which of the following are you enrolled in?*

an on-campus degree program/classes that would be offered in-person under normal circumstances
a CSU online degree program
Don't know
Other

Which of the following do you identify with? Please check all that apply.

Are you a first generation college student?

Yes
No
N/A

Are you a veteran?

Yes
No

Preferred Language

We offer in-house Conflict Resolution Services in English and Spanish, and translation services for other languages.

English
Spanish
Other

For translation services, please select one of the following languages:

Please provide a brief description of the issue:*

What type of situation are you seeking assistance with?*

How did you find out about Conflict Resolution?*

What type of appointment would you prefer?*

Phone call
Video chat

CONFIDENTIALITY:*

Information shared with Conflict Resolution Services will be kept confidential to the extent permitted by law. EXCEPTIONS: Staff are required to report any and all information related to incidents of sexual misconduct and/or interpersonal violence to the Office of Title IX Programs and Gender Equity. Allegations of child abuse or credible threats of future harm to any person shall not be held confidential and may be revealed as appropriate by staff.

I understand and agree to these conditions.

Comments

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