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Counselling Services

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Counselling Appointment Request Form

For general questions about studying at Athabasca University, please contact the Athabasca University Information Centre.

Please complete and submit this form to request a confidential telephone session with an Athabasca University Counsellor. You will receive an e-mail confirming your appointment. Once confirmed, an AU counsellor will contact you to initiate the session.

Contact Information

*First Name:
*Last Name:
AU Student ID#:
Street Address:
Postal/Zip Code:
*E-mail Address:
  (Area code)   Telephone Number
*Home Telephone Number ( )    
Work Telephone Number ( )    
*At which number do you wish to be called for your appointment?



Yes No   *I am an AU student, and was referred by Student Financial Aid regarding readiness for full-time funded studies


Counselling Issues

Choose from the list below which topics you would like to discuss with a counsellor. You may select as many topics as you like. Click on the text links for more information.

Education & Career Planning

Learning Support (For AU students)



Please add relevant information here (try to limit your comments to fewer than 100 words)

*Request an Appointment Date and Time

Please schedule an appointment at least three calendar weeks from today's date.

Appointments are typically scheduled 9 a.m. to 3:30 p.m. Mountain Time; closed Saturdays, Sundays, and holidays. There is no charge for the telephone counselling session.

It is now 10:01 pm Mountain Time in Athabasca.

I wish to schedule a counselling session on the
of , at Mountain Time.

I was Referred by...

To help us improve our services, please tell us how you heard about Athabasca University’s Counselling Services.

Other - please indicate how you heard about AU’s Counselling Services
The personal information collected on this form will be used to process your request for a counselling session and is collected under the authority of section 33 (c) of the Alberta Freedom of Information and Protection of Privacy Act. If you have any questions about the collection or use of this personal information, contact Counselling Services, Athabasca University, 1 University Drive, Athabasca AB T9S 3A3; Telephone (780) 675-6723; e-mail


SAS for Learner Support Services - Last Updated February 14, 2019