Bryn Mawr College

*indicates required information

First Name*:

Last Name*:

Phone*:

BMC Email*:

Preferred Contact Method*: Select One Email Phone

Dorm*: Select One Batten House Brecon Denbigh Erdman Haffner Merion Pem East Pem West Perry House Radnor Rhoads South Rhoads North Rockefeller Off-Campus

Please indicate which services you think might work best for you (check all that apply):

ARGH!
Counseling Services
Dean's Office
Facilitated Dialogue
HA/Customs
Intercultural Affairs
Mediation
Residential Life
I'm not sure which service I need.

If you would like to schedule an appointment with any of these services, please indicate when you will be available during the next two weeks (This information is not required to submit this form. However, providing it may reduce the amount of time it takes to schedule appointments.):

If you are interested in working with others with whom you are in conflict, list their name(s) and let us know whether or not you have discussed anything with them (This information is not required.):

In order for us to help you, we will need to understand your situation. If you wish, you may give us a brief description of the issue in the space provided below. If you do not wish to send this information via email, or if your situation is too complex, we will be happy to discuss it with you in a meeting or over the phone:

Please note that appointments will be much easier to schedule if all parties are aware that assistance is being sought to work towards resolution of issues. If you haven't talked to the other person(s), you may want to do that now. If you have questions or concerns about how to approach the other person(s), we can help you take initial steps once we have contacted you.

After your information is received, you will be contacted within 2 days for an initial conversation and to schedule any appropriate appointments.

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