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Student Life & Services

Counseling Services Request Form

This request will be processed within 48 hours during the semester's business hours.

If this is an emergency dial 911 and/or proceed to your nearest emergency facility.

Please complete the following fields to request a counseling appointment.

The counseling office will likely contact you through your Kent e-mail account;
please check that e-mail for the response.

Campus Currently Attending:

East Liverpool

Salem

First Name:

Last Name:

Banner or SS Number:

Street Address:

City:

State:

Zip:

E-mail address:

Contact Phone:

Emergency Contact Name:

Emergency Contact Phone:

Briefly describe why you are interested in counseling services:

Indicate when it is best for you to meet (days of the week and times):

Connect with Columbiana

Kent State University 400 East 4th Street East Liverpool, Ohio 43920 Phone: 330-385-3805 Driving Directions
Kent State University 2491 St. Rt. 45 South Salem, Ohio 44460 Phone: 330-332-0361 Driving Directions