Student Counselling Request

Use this short form to request a confidential counselling session. Required fields are marked and highlighted with a red underline as in the college reference layout.

Fields marked * are required. Counsellor gender preference will be accommodated where possible.

Full Name *

Email *

Phone (WhatsApp preferred) *

Department *

Class Roll No.

Year / Semester

Primary concern *

Preferred counsellor gender (optional)

No preference Female Male

Preferred mode

Details of concern (2–4 sentences) *

Availability / preferred days & times

If urgent, indicate 'urgent' and call the emergency helplines listed on the dashboard.

I consent to share this information with the RGIT Wellness Cell and SBC3 / Energetix team for arranging counselling. I understand information is treated confidentially.

Prefer a paper copy? Download the PDF form