University Counseling Services UCS Group and Workshop Interest Form Name(Required) First Last CSUN ID #(Required)Date MM slash DD slash YYYY Group I'm Interested in Attending – #1(Required)SelectAnxiety ToolboxBe Body PositiveFamily MattersFlutter: Undocumented StudentsGraduate Student SupportGrief and LossInternational Student SupportLGBTQIA+ SupportLove Your #SelfieMen’s Group: Dating and RelationshipsParenting SupportRefocus: Group for Students with ADHDTrans, Nonbinary, and Gender Expansive SupportUnderstanding Self and OthersWe're FirstWho Am I?Winning at EmotionsWomen's SupportWriter's BlockGroup I'm Interested in Attending – #2NoneAnxiety ToolboxBe Body PositiveFamily MattersFlutter: Undocumented StudentsGraduate Student SupportGrief and LossInternational Student SupportLGBTQIA+ SupportLove Your #SelfieMen’s Group: Dating and RelationshipsParenting SupportRefocus: Group for Students with ADHDTrans, Nonbinary, and Gender Expansive SupportUnderstanding Self and OthersWe're FirstWho Am I?Winning at EmotionsWomen's SupportWriter's BlockGroup I'm Interested in Attending – #3NoneAnxiety ToolboxBe Body PositiveFamily MattersFlutter: Undocumented StudentsGraduate Student SupportGrief and LossInternational Student SupportLGBTQIA+ SupportLove Your #SelfieMen’s Group: Dating and RelationshipsParenting SupportRefocus: Group for Students with ADHDTrans, Nonbinary, and Gender Expansive SupportUnderstanding Self and OthersWe're FirstWho Am I?Winning at EmotionsWomen's SupportWriter's BlockGroup I'm Interested in Attending – #4NoneAnxiety ToolboxBe Body PositiveFamily MattersFlutter: Undocumented StudentsGraduate Student SupportGrief and LossInternational Student SupportLGBTQIA+ SupportLove Your #SelfieMen’s Group: Dating and RelationshipsParenting SupportRefocus: Group for Students with ADHDTrans, Nonbinary, and Gender Expansive SupportUnderstanding Self and OthersWe're FirstWho Am I?Winning at EmotionsWomen's SupportWriter's BlockGroup I'm Interested in Attending – #5NoneAnxiety ToolboxBe Body PositiveFamily MattersFlutter: Undocumented StudentsGraduate Student SupportGrief and LossInternational Student SupportLGBTQIA+ SupportLove Your #SelfieMen’s Group: Dating and RelationshipsParenting SupportRefocus: Group for Students with ADHDTrans, Nonbinary, and Gender Expansive SupportUnderstanding Self and OthersWe're FirstWho Am I?Winning at EmotionsWomen's SupportWriter's BlockHow did you find out about UCS Groups? Brochure Campus Fair Class Presentation Counseling Services Daily Sundial Faculty/Staff Flyer/E-mail Friend Website OtherContacting Me In order to keep my relationship with UCS confidential, the best way to contact me is via the confidential messaging system within UCS’ Electronic Health Management system, Point and Click. This system will notify me with an email to my CSUN email account with the subject line "Important message from Klotz Student Health Ctr or the Oasis Wellness Ctr and/or Univ. Counseling Services provider." Upon receipt of this email, I will need to log on to the MyHealth@CSUN portal to access the message. However, should the need arise to contact me by other means, the best way to contact me is noted below. I give permission for UCS to contact me by the following means. I am aware that information exchanged over a cell phone and e-mail could be intercepted by an outside party.Best Contact NumberPhone Type Cell Home Work Okay to Leave a Message at This Number? Yes No