This form is for Japan Admit students and graduate students only. Please answer all of the following questions.

*What is your name (i.e., last, middle, first name)?(Required.)

*What is your TU ID number?(Required.)

*What is your TU email address?(Required.)

*What is your student status?
If you are a Study Abroad or TJEY student, please contact Healix (at +1 267-855-1884 or temple@healix.com) to make individual therapy appointments, instead of completing this form.(Required.)

Japan Admit (JA)

Graduate Student

*What is your session style preference?
Please note that our in-person slots are limited. If you are open to zoom sessions, you will have a better chance of being assigned a therapist.(Required.)

In-person only

Zoom

If In-person session slot is not available, Zoom sessions are fine.

For the following 4 questions regarding your availability for the sessions, if you do not provide specific availability (for example, MWF 10am-1pm, TTh 1pm-5pm), we will not be able to assign you a therapist.

If you are available online (Zoom), please write your availability between Mondays to Fridays 10am to 5pm (for example, MWF 10am -1pm TTh 1pm-5pm).

If you are available to meet at City Campus, please write your availability between Mondays to Fridays 10am to 5pm (for example, MWF 10am -1pm TTh 1pm-5pm).

If you are available to meet at Hillside Center, please write your availability between Mondays to Fridays 10am to 5pm (for example, MWF 10am -1pm TTh 1pm-5pm).

If you are available to meet at TUJ Kyoto, please write your availability between Mondays to Fridays 10am to 5pm (for example, MWF 10am -1pm TTh 1pm-5pm).

What is your preferred language? You can check all answers that apply.

English

Japanese

Korean

Portuguese (Br)

Turkish

*What are your main concerns that you would like to address in your sessions?(Required.)

Would you prefer to meet a neurodivergent specialist? If your answer is "yes," please explain what you would like to work on with the neurodivergent specialist. If your answer is "no," please skip this question.

Thank you very much for completing the form. We assign therapists to students every Wednesday. You should hear from your therapist or TUJ Counseling Center within the 2-3 business days following Wednesdays. We appreciate your patience.

If you are experiencing a mental health crisis or emergency, please contact TELUS at 0800-222-1148 (Students with Japanese phone carriers) or +1 833-799-5440 (Students with American phone carriers).