REQUEST AN APPOINTMENT

Name*
First Last
Email*
Phone
Tusculum ID Number
Please enter your Tusculum ID, if known
Type of Request*
Counseling Request
Please list three days and times that you would be available for counseling.
1. Date
MM slash DD slash YYYY
Time

: Hours

Minutes

AM/PM
2. Date
MM slash DD slash YYYY
Time

: Hours

Minutes

AM/PM
3. Date
MM slash DD slash YYYY
Time

: Hours

Minutes

AM/PM
More Information
Please enter more information about the reason(s) you wish to schedule a counseling session.
ADA Accommodation Request
Do you have support documentation for your accommodation request?*
- YES
- NO
Supporting documentation should be sent to Dr. Michell Temple, Counselor and ADA Coordinator.

You may attach the documentation to an email and send to: counselingandadaservices@tusculum.edu

You may also drop off the documentation. Dr. Temple's office is located in room 233 of the Thomas J. Garland Library on the Greeneville campus.

Counseling Request