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 Other What year are you in school? First Year Sophomore Junior Senior Graduate Student Are you a part-time student (less than 12 credits)? Yes No N/A Which of the following are you enrolled in:* on-campus degree program/classes that would be offered in-person under normal circumstances degree program through CSU online. not sure other Please 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 Self-identify Prefer not to disclose Self-identify:Are you a first generation college student? Yes No N/A Are you a veteran? Yes No Preferred Language*(We offer translation services if desired) English Other For translation services, please select one of the following languages:N/AArabicBosnianBrazilian PortugueseCambodianCantoneseCroatianFarsiFrenchGermanHaitian CreoleHindiHmongJapaneseKoreanLaoMandarinPunjabiRomanianRussianSerbianSomaliSpanishThaiTagalogVietnameseWhat would you like to speak to Conflict Resolution staff about? (check all that apply)* academic misconduct appeals accomodations/accessability bias/discrimination course curriculum/content a conduct case Conflict Dynamics Profile CSU policies a degree program employment/supervision graduate advising roommate(s)/living situation an organization/team/club a personal relationship staff behavior/service professor/instructor behavior restorative justice self-improvement/skill development Other Brief description of the situation:*How did you learn of Conflict Resolution Services?* campus ads student CSU employee presentation/event internet search facebook instagram other Please specify:Please specify: Advisor Case Management Department Chair Health Network Student Legal Services Professor/Instructor Ombuds Parent and Family Programs Student Conduct Student Disability Center Tell Someone University Housing Other When are you typically available to meet? (check all that apply)*Appointments generally last 45-60 minutes. Office hours are 8:00AM-5:00PM (mountain time), Monday through Friday. I already have an appointment Mondays Tuesdays Wednesdays Thursdays Fridays Mondays between the hours of:* 8:00AM-11:00AM 11:00AM-2:00PM 2:00PM-5:00PM Tuesdays between the hours of:* 8:00AM-11:00AM 11:00AM-2:00PM 2:00PM-5:00PM Wednesdays between the hours of:* 8:00AM-11:00AM 11:00AM-2:00PM 2:00PM-5:00PM Thursdays between the hours of:* 8:00AM-11:00AM 11:00AM-2:00PM 2:00PM-5:00PM Fridays between the hours of:* 8:00AM-11:00AM 11:00AM-2:00PM 2:00PM-5:00PM What 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) Do you require a disability related accommodation for this meeting? Yes No Please specify: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. EmailThis field is for validation purposes and should be left unchanged.