COVID-19 UPDATE: Conflict Resolution appointments will take place via PHONE or VIDEO CHAT until further notice. Please indicate your preference on the form, below. Conflict Resolution Appointment Request Form Name* First Last Preferred NamePronounsCSU ID #*Email* Phone*Which best describes your role at CSU? (check all that apply)* Student Faculty/Instructor Staff OtherWhat year are you in school? First Year Sophomore Junior Senior Graduate StudentAre you a part-time student (less than 12 credits)? Yes No N/AWhich of the following are you enrolled in:* an on-campus degree program/classes that would be offered in-person under normal circumstances a degree program through CSU online. Not sure OtherPlease indicate which of the following you most identify with (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 Multi-Racial Some other race, ethnicity, or origin Prefer not to discloseAre you a first generation college student? Yes No N/AAre you a veteran? Yes NoPreferred LanguageWe offer translation services if needed. English Spanish OtherFor translation services, please select one of the following languages:N/AArabicBosnianBrazilian PortugueseCambodianCantoneseCroatianFarsiFrenchGermanHaitian CreoleHindiHmongJapaneseKoreanLaoMandarinPunjabiRomanianRussianSerbianSomaliSpanishThaiTagalogVietnameseWhat type of situation are you seeking assistance with? (check all that apply)* Academic matters Academic misconduct Advisor issues Appeals Bias Student conduct case Classmate/teammate challenges Conflict Dynamics Profile Student/faculty challenges General learning/skill development Grade dispute Graduate Program Issues Student org issues Impact circles Restorative Justice Roommate challenges University policies Workplace problems OtherBrief description of the situation:*How did you find out about Conflict Resolution?* Advisor Ads on campus Student Case Management CSU staff Health Network Presentation/event Student Legal Services Professor/instructor Department chair SRC website Tell Someone Social Media University Housing Web search OtherOther referral source:Which of the following days/times (please use Mountain Time) are you available for an appointment? (Check all that apply)*Appointments last between 45-60 minutes. Business hours are Monday - Friday, between 8:00 AM to 5:00 PM (MT) I already have an appointment Monday morning Monday afternoon Tuesday morning Tuesday afternoon Wednesday morning Wednesday afternoon Thursday morning Thursday afternoon Friday morning Friday afternoonWhat type of appointment do you prefer?* Phone call (dial the number in the email we send) Video chat (click the link in the email we send)We will set you up for a Microsoft Teams appointment. Details for that appointment will be emailed to you and you may choose to call in or click the link for a video call.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.