Conflict Resolution Intake Form 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 Form1. Name* First Last Preferred NamePronounsCSU 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. Asian Black, Afro-Caribbean, or African American Latin@, Hispanic, or Spanish origin Native American or Alaskan Native Native Hawaiian or other Pacific Islander Middle Eastern or North African White/Caucasion Multi-Racial Some other race, ethnicity, or origin Prefer to not disclose Are you a first generation college student? Yes No N/A Are you a veteran? Yes No Preferred LanguageWe 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:N/AArabicBosnianBrazilian PortugueseCambodianCantoneseCroatianFarsiFrenchGermanHaitian CreoleHindiHmongJapaneseKoreanLaoMandarinPunjabiRomanianRussianSerbianSomaliSpanishThaiTagalogVietnamesePlease provide a brief description of the issue:*What type of situation are you seeking assistance with?* Academic matters Academic misconduct Classroom conflict Student conduct Bias Faculty/student challenge Grade dispute Personal safety Restorative Justice intake Roommate conflict Student organization conflict University policies and procedures Workplace dispute Other How did you find out about Conflict Resolution?* Advisor Ads on campus Another student Case Management Collegian Court Department Chair Health Network Presentation/event Student Legal Services Professor/Instructor SRC Website Tell Someone Social Media University Housing Web search Other 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. CommentsThis field is for validation purposes and should be left unchanged.