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:

• This form is typically used for students writing a news story or working on a class project related to mental health. If you are interested in scheduling a counseling appointment, please call (616) 331-3266 or visit the University Counseling Center in 206 STU.
• 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 Thriving Campus. 
• Interviews are scheduled for 30 minutes and conducted with a member of the University Counseling Center staff knowledgeable in the subject requested.  
• Questions must be submitted in advance; 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, please 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 *

What is the general topic of the interview? *

Please provide a prepared list of questions below: *

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? *
- Select Option Virtual (you will be responsible for providing the assigned counselor a link) In-person: Allendale Campus 206 STU In-person: Pew Campus DEV 101B

Do you intend to audio or video record the interview? Please note that counselors can decline recording. *
Yes
No

As noted, the University Counseling Center is unable to accommodate requests made less than one week in advance. Is there at least one week between the submission of this request and the date by which the interview needs to be conducted? *
Yes
No

What specific days/times are you available to conduct the interview? Please provide more than 1 option. *

Special Requests or Further Instructions

I understand that I will be contacted by a member of the University Counseling Center staff within two business days to schedule an interview.  Interviews are subject to the aforenoted policies and counselor availability.

I have read and agree to the above statement *
Yes