Workshop and Group Interest Form

University Counseling Services (UCS) will be offering many of its groups and workshops virtually via telemental health for currently enrolled students via Zoom Health.

Name: *

CSUN ID#: *

Date:

Month

Day

Year

Groups I'm Interested in Attending:

1 *

How did you find out about UCS Groups?

(Check all that apply)

Other:

Contacting Me

In order to keep my relationship with UCS confidential, the best way to contact me is via the confidential messaging system within UCS' Electronic Health Management system, Point and Click. This system will notify me with an email to my CSUN email account with the subject line "Important message from Klotz Student Health Ctr or the Oasis Wellness Ctr and/or Univ. Counseling Services provider." Upon receipt of this email, I will need to log on to the MyHealth@CSUN portal to access the message. However, should the need arise to contact me by other means, the best way to contact me is noted below.

I give permission for UCS to contact me by the following means. I am aware that information exchanged over a cell phone and e-mail could be intercepted by an outside party.

Best Contact Number

Phone Type:

Cell

Home

Work

Okay to Leave a Message at This Number:

Yes

Leave this field blank

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