Skip to main content
+ Login
Home
Boards
Library
Los Angeles
New York
Miami
Events
Directory
Projects
Student Services
Los Angeles
Campus Updates
Academic Affairs
Accessibility Services
Badges
Building Hours & Holidays
Counseling
Dean of Students
Resource Directory
Study Tips
Student Conduct
Student Grievances
Drug and Alcohol Policy
Semester Welcome Information
Diversity, Equity, Inclusion
RaceRelay: Race Relations Community Dialogue
Film Dept
Certified Covid Officer Approval Form
Crew Report- Lined
Crew Report- Unlined
Director's Report- Lined
Director's Report- Unlined
Film / Cine / Producing - Casting Request
Film / Cine / Producing - Room Request
Greenlight Form
Overseas Greenlight Form
Reshoot Pickup Form
Semester One NonSync Greenlight Form
Graduation
Housing Dept
Parking at Nyfa
Post Production
Registrar
Screenwriting Dept
Screenwriting - Casting Request
Screenwriting - Room Reservation
Student Activities
Title IX & Sexual Misconduct
Bystander Intervention and Risk Reduction
Domestic Violence Awareness Month
Seeking Medical Attention and Preserving Evidence
Sexual Misconduct Resources and Support
Student Bill of Rights
Veteran Services
New York
Accessibility Services
Counseling
Dean of Students
Student Conduct
Student Academic Integrity Incident Report Form
Student Conduct Incident Report Form
Student Injury/Illness Incident Report Form
Drug and Alcohol Policy
Grievance Procedure
Study Tips
Where To Go To Get What You Need
English Language Lab
Registrar
Veteran Services
Title IX & Sexual Misconduct
Bystander Intervention and Risk Reduction
Domestic Violence Awareness Month
Seeking Medical Attention and Preserving Evidence
Sexual Misconduct Resources and Support
Student Bill of Rights
Academic Calendar
Spring 24
Summer 24
Diversity, Equity, and Inclusion Council
Library
Where To Go To Get What You Need
Miami
Accessibility Services
Acting Dept
Acting Thesis Package
Equipment Request Form
Props Request Form
Room Request Form
Counseling
Intake Form
Mental Health Apps
Minor Consent for Treatment Form
Treatment Agreement
Dean of Students
Dean of Students
Dean’s List
Drug and Alcohol Policy
Library
Registrar
Student Conduct
Study Tips
Title IX & Sexual Misconduct
Bystander Intervention and Risk Reduction
Domestic Violence Awareness Month
Seeking Medical Attention and Preserving Evidence
Sexual Misconduct Resources and Support
Student Bill of Rights
Veteran Services
Where To Go To Get What You Need
Florence
Accessibility Services
COVID Safety Plan
Handbooks
Academic Affairs Office
Competitions Office
Dean Of Students Office
Faculty Staff Directory
Handbooks
International Office
Office Directory
Student Directory
Title IX Office
Veterans Office
Counseling SB Intake Form
Breadcrumb
Home
Counseling SB Intake Form
Campus
Los Angeles
New York
South Beach
Name
Date of Birth
Phone
Email
In case of emergency
Current year and program
Ethnicity
Relationship status
Current living situation
Please describe your current concerns, challenges or symptoms?
Who referred you to counseling?
Have you had previous counseling (If so, please list when and with whom)?
Please list any current and or past medication within the past two years (please include dosage, if and when possible)
Please list family members with any current or previous emotional or physical health concerns/challenges
Current strengths/healthy coping
Moods/Behaviors
anxious/worried
depressed/unhappy
eating disorder/body image concerns
hyperactive/inattentive
shy/withdrawn
low self-esteem
aggressive behaviors
stealing/lying
other
Other moods/behviors
School Concerns
homework challenges
low test/assignment grades
poor classroom performance
sleeping in class/always tired
sudden change in grades
frequently tardy or absent
new student
other
Other School Concerns
Relationships
bullying
difficulty making friends
poor social skills
problems w/ friends
boy/girl friend issues
other
Other Relationships
Home Concerns
fighting w/ family members
illness/death in the family
parents divorced/separated
physical/sexual abuse
drug/substance abuse
parent request
other
Other Home Concerns
