Please complete this form to request an appointment for an individual, family or relationship counseling session.

Please note: It may take up to 2 business days to respond to your completed form.

Eligibility

  • FSAP services are only available for CU Boulder staff, faculty and employees.
  • Non-affiliates and fully retired employees are not eligible for FSAP.
  • Student workers and graduate students should contact Counseling and Psychiatric Services (CAPS) for support.
  • If you are a UCCS employee, please use our UCCS form.

CU Boulder staff, faculty and employees are eligible for seven (7) free counseling sessions per rolling year.

 Important note: State law requires FSAP counseling clients to be physically located in the state of Colorado at the time of service. We cannot provide counseling to clients who are temporarily or permanently located outside of Colorado. 

Urgent support

If you need urgent or crisis support, please call the Real Help Hotline at 833-533-2428, visit your nearest emergency department or contact 911.

This form should not be used for emergencies and is not monitored 24/7.

If no, you may not be eligible for FSAP services. If you are a student, student employee or graduate student, please contact Counseling and Psychiatric Services (CAPS).
State law requires all counseling clients to be physically present in the state of Colorado at the time of service. If you will not be in Colorado at the time of your appointment, please indicate when you will be or wait to submit this form until you’re in Colorado.
Please include your preferred name (ex. Ralph “Ralphie” the Buffalo) if it differs from your legal name.
Learn more at: https://www.colorado.edu/cisc/pride-office/lgbtq-resources/pronouns
Your IdentiKey helps us verify your identity. If you don’t know your IdentiKey, put ”Unsure”.
If you would like to receive communications from FSAP at an email not affiliated with CU, please list it here. If you’d like to be contacted through your CU Boulder email, leave this area blank.
FSAP is unable to leave messages if your voicemail is full or not set up. Phone settings like ‘do not disturb,’ silencing or unknown number blocks may also prevent receiving our calls.
You and your provider may change this for future appointments.
Please tell us in a few short sentences about what you’d like to discuss with your FSAP counselor.
We will contact you by email unless otherwise instructed. If you do not respond after up to two attempts, you will need to complete this form again. I understand and accept
Is there any additional information you’d like for us to know?