Counseling Services Request for Information Call

In the case of a life-threatening emergency, call University Police at Ext. 5911. EMS will be activated.

Request for Information Call
*First Name: 


*Last Name: 


*Student ID#: 


*Date of Birth:  
 (MM/DD/YYYY) 

*Phone: 


*Lewis Email: 


*Student Type: 
 Commuter
 Resident

*Preferred Date:
  

*Preferred Time for Follow-Up: 
 Morning
 Afternoon

*I give permission for Counseling Services to utilize my email for communication regarding this information request:
 Yes
 No

*I give permission for Counseling Services to utilize my cell phone for communication regarding this information request:
 Yes
 No

Security Password (Please type the word ):




For emergency support (365 days per year - 24/7)

Lewis University Police Department:
Emergency: 815-836-5911
Non-emergency: 815-836-5222

Crisis Text Line: text HOME to 741741

https://suicidepreventionlifeline.org/
1-800-273-TALK (8255)