CEW+ Counseling Appointment Request Form

CEW+ Counseling Appointment

Request Form

CEW+ Counseling Appointment Request

Please fill out this confidential form to request an appointment with a CEW+ Counselor. Within 2 business days after your form is submitted, a member of our team will be in touch (via phone or email) to formally schedule your appointment.

You can also call 734-764-6360 to schedule an appointment.

First Name*

Last Name*

Preferred Name

If not first name.

Email*

Phone Number*

Pronouns

How would you prefer to be contacted?*

We do the majority of our scheduling via email. If you would prefer to schedule via phone, select phone.

However, please be advised that scheduling confirmation and reminders, and additional information will be sent via email.

Phone

Have you had an appointment with CEW+ before?*

Select

What state will be you located in at the time of your appointment?

Select

Due to intrastate licensure issues, appointments are only open to residents of the State of Michigan, unless you are an actively enrolled U-M student, staff or faculty, or CEW+ Scholar Alum, or relocating to Ann Arbor with your spouse/partner who is attending or will attend or work for U-M.

I understand*

Are you a School of Social Work (SSW) student, staff, or faculty member?*

Select

Agreement to Proceed

By checking "I understand," you agree that, if you are outside the State of Michigan at the time of your appointment, you meet one of the criteria above which allows you to have an appointment with a CEW+ counselor. If this is the case, please complete and turn in this request. If it is not, or you are not sure, please contact CEW+ at cew.appts@umich.edu or 734-764-6360.

On which campus are you a student?*

Select

Are you a current or former CEW+ scholar?*

Select

Type of Appointment (Student)*

Select or enter value

CEW+ Emergency Fund Eligibility

Please review these eligibility requirements prior to requesting an appointment for Emergency Funds (EF). If you do not meet the requirements, you may still schedule an appointment, but please select "Education Counseling" above to meet with a counselor to discuss your situation.

Your request must fit within the following parameters:

Request is to cover unexpected or unanticipated emergent expense(s) (note: receipts and other documentation may be requested).
A current FAFSA is on file with the Office of Financial Aid (this criterion will be waived if you are ineligible to complete FAFSA, i.e. international or undocumented students).
There is unmet need in your financial aid package.
You are an enrolled U-M Ann Arbor student or enrolled CEW+ Scholar from the Dearborn or Flint campus.
You have not already received Emergency Funds from CEW+ in the current academic year.

More information about applying for EF is available here.

Yes, my request fits the parameters.*

Type of Appointment (Non-student)*

Select or enter value

In which format would you like your appointment to be?*

Select

Have you contacted any other departments about your request?*

Select

Which department(s) have you contacted?*

List name and contact information for departments you contacted, if available.

Briefly describe reason for appointment:*

Additional Comments:

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