If you are a distance learner, we can provide meetings via phone or video conferencing.Conflict Resolution Appointment Request Form Name* First Last Preferred NamePronounsCSU ID #*Email* Phone*Which best describes your role at CSU? Student Faculty/Instructor Staff OtherWhat year are you in school? First Year Sophmore Junior Senior Graduate StudentAre you a part-time student (less than 12 credits)? Yes No N/APlease indicate which of the following you most identify with: Native American or Alaskan Native Black or African American Asian/Pacific Islander Hispanic or Latin@ Middle Eastern/North African/Arab Multi-Racial White Self-IdentifyPreferred LanguageWe offer in-house Conflict Resolution Services in English and Spanish, and translation services for other languages. English Spanish OtherFor translation services, please select one of the following languages:N/AArabicBosnianBrazilian PortugueseCambodianCantoneseCroatianFarsiFrenchGermanHaitian CreoleHindiHmongJapaneseKoreanLaoMandarinPunjabiRomanianRussianSerbianSomaliSpanishThaiTagalogVietnameseWhat type of situation are you seeking assistance with?* Academic matters Academic misconduct Classroom conflict Complete the Conflict Dynamics Profile Assessment Conduct Appeal Discrimination Faculty/student conflict Grade dispute Personal safety Roommate conflict Student organization conflict Tell Someone University policies and procedures Workplace dispute OtherPlease describe:Brief description of the situation:*How did you find out about Conflict Resolution? Advisor Ads on campus Another student Case Management Collegian Court CSU staff Health Network Presentation/event Student Legal Services Professor/Instructor SRC Website Tell Someone Social Media University Housing OtherOther referral source:Which of the following days/times are you available for an apppointment?*Appointments typically last between 45-60 minutes. Business hours are Monday - Friday, between 8:00 AM to 5:00 PM. 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? In person meeting Phone call (we'll call you at the number provided) Video chat (we will email you to set up a session)Information regarding confidentiality:*In most circumstances, what you share with Conflict Resolution staff will be kept confidential. Exceptions under the law include a court order, imminent danger to yourself and others, child abuse, sexual harassment and discrimination. These must be reported to the Office of Equal Opportunity and/or another appropriate authority. If your situation does not involve any of these circumstances, then all contacts, records, and communications will be kept confidential at Conflict Resolution Services. If you would like to talk to someone with full confidentiality privileges, please contact Counseling Services, the Women and Gender Advocacy Center, Student Legal Services, or personnel at the CSU Health Network. I understand and agree to these conditions.CommentsThis field is for validation purposes and should be left unchanged.