New Request for Counseling
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New Request for Counseling

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All fields marked with * are required.
*Date
*Last Name
*First Name
*Date of Birth:
*Age:
*Gender
*Marital Status
*Local Address
Counseling Services is only able to provide counseling for those students who are able to come into our offices on campus in Virginia Beach.
*City
*State
*Zip Code
*Phone
*Regent Email
*Student Registration Status
*I primarily study:
*Select Your Degree
*Projected Date of Graduation
*Did someone refer you to counseling?
*Please check all reasons that apply for your choice to seek counseling
Additional Comments
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