Thank you for your interest in interviewing a member of the University Counseling Center staff.  While maintaining our focus on providing mental health treatment to the Grand Valley community, we make every effort to accommodate student requests.   Before completing the form below, please note the following:

• Requests for interviews must be made no less than one week prior to the date of the interview.
• During peak clinical times, the University Counseling Center staff may be unable to fulfill requests due to limited counselor availability.  Should this happen, a list of local mental health providers can be found on our website. 
• Interviews are scheduled for 30 minutes and conducted with a member of the University Counseling Center staff knowledgeable in the subject requested.  Staff do not complete interviews via email at this time.
• Questions should be submitted in advance, either on the form below or directly to the counselor assigned.  This provides an opportunity for our counselors to prepare and maximizes the time allotted.

The above are general guidelines of the University Counseling Center.  If you have an exception that you would like considered, you may contact the Center at (616) 331-3266.

I have read and agree to the above listed guidelines. *
Yes

First Name *

Last Name *

Status *
- Select Option GVSU Student GVSU Faculty/Staff Not listed Please specify a value for Status

Email *

Email (Confirmation) *

Phone *

Topic/Prepared questions for counselor: *

What is the interview for? *
- Select Option Class Lanthorn Research Not listed Please specify a value for What is the interview for?

Where would you like to conduct your interview? (Note: In-person interview requests are subject to availability and will follow recommended safety guidelines). *
- Select Option Virtual In-person: Allendale Campus 204 STU In-person: Pew Campus DEV 101B

Will there be other individuals interviewing with you? *
- Select Option Yes No

Please provide the names of the individuals attending the interview with you. *

Dates you would have availability (one week from today): *
Monday
Tuesday
Wednesday
Thursday
Friday

Please mark your availability. Interviews are scheduled for 30 minutes and will be scheduled on either the hour or half hour. *
M: 8:00 a.m. - 9:00 a.m.
M: 9:00 a.m. - 10:00 a.m.
M: 10:00 a.m. - 11:00 a.m.
M: 11:00 a.m. - 12:00 p.m.
M: 1:00 p.m. - 2:00 p.m.
M: 2:00 p.m. - 3:00 p.m.
M: 3:00 p.m. - 4:00 p.m.
M: 4:00 p.m. - 5:00 p.m.

Please mark your availability. Interviews are scheduled for 30 minutes and will be scheduled on either the hour or half hour. *
T: 8:00 a.m. - 9:00 a.m.
T: 9:00 a.m. - 10:00 a.m.
T: 10:00 a.m. - 11:00 a.m.
T: 11:00 a.m. - 12:00 p.m.
T: 1:00 p.m. - 2:00 p.m.
T: 2:00 p.m. - 3:00 p.m.
T: 3:00 p.m. - 4:00 p.m.
T: 4:00 p.m. - 5:00 p.m.

Please mark your availability. Interviews are scheduled for 30 minutes and will be scheduled on either the hour or half hour. *
W: 8:00 a.m. - 9:00 a.m.
W: 9:00 a.m. - 10:00 a.m.
W: 10:00 a.m. - 11:00 a.m.
W: 11:00 a.m. - 12:00 p.m.
W: 1:00 p.m. - 2:00 p.m.
W: 2:00 p.m. - 3:00 p.m.
W: 3:00 p.m. - 4:00 p.m.
W: 4:00 p.m. - 5:00 p.m.

Please mark your availability. Interviews are scheduled for 30 minutes and will be scheduled on either the hour or half hour. *
Th: 8:00 a.m. - 9:00 a.m.
Th: 9:00 a.m. - 10:00 a.m.
Th: 10:00 a.m. - 11:00 a.m.
Th: 11:00 a.m. - 12:00 p.m.
Th: 1:00 p.m. - 2:00 p.m.
Th: 2:00 p.m. - 3:00 p.m.
Th: 3:00 p.m. - 4:00 p.m.
Th: 4:00 p.m. - 5:00 p.m.

Please mark your availability. Interviews are scheduled for 30 minutes and will be scheduled on either the hour or half hour. *
F: 8:00 a.m. - 9:00 a.m.
F: 9:00 a.m. - 10:00 a.m.
F: 10:00 a.m. - 11:00 a.m.
F: 11:00 a.m. - 12:00 p.m.
F: 1:00 p.m. - 2:00 p.m.
F: 2:00 p.m. - 3:00 p.m.

Special Requests or Further Instructions

I understand that an interview is not confirmed until I receive an email from the University Counseling Center office coordinator with a scheduled date and time.  If the office coordinator is unable to match my preferred dates and times with an available clinician one week from this request, I will be contacted via email or by phone.

I have read and agree to the above statement *
Yes