Appointment Request Form

Last Name

First Name

Student ID

Confidential Phone (a number where we can leave a message for you without violating your confidentiality or safety)

Other Phone

Confidential Email Address (where we can confirm your appointment and send general information to you)

Student Year/Status

Major/Program

Street

City

State

Zip Code

Monday

Tuesday

Wednesday

Thursday

Friday

Additional Scheduling Information

Criminal

Family Law

Do you have documents pertaining to this issue? (If yes, please bring all documents to your appointment for attorney to review)

Please write a brief description of your legal concern and relevant circumstances; tell us what has happened:

What do you want out of this consultation?

Age

Gender

Ethnic Origin

If you are a foreign student, what is your country of origin?

How did you learn about Student Legal Services?