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The Harassment Counseling Center Online Form
● For all appointments and inquiries, please fill out and send the form below.
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Email
*
Your email
E-mail (for confirmation)
*
Your answer
Reason for Contacting the HCC
*
Appointments
Inquiries
Other
Name
*
Your answer
Mobile Phone Number
*
Your answer
Position or Status Associated with UTokyo
*
Choose
Undergraduate Student (incl. Research Student)
Graduate Student
Researcher (incl. Postdoctoral Researcher)
Faculty
Staff
Family of UTokyo Member
Other
Have you used the Harassment Counseling Center before?
*
No, this is my first time.
Yes, I have.
Preferred Session Medium
*
Zoom (Unavailable if you wish to remain anonymous)
In-person (Unavailable if you wish to remain anonymous)
By Phone
By E-mail
No Preferences, any medium is fine
1st Choice
2nd Choice
3rd Choice
Zoom (Unavailable if you wish to remain anonymous)
In-person (Unavailable if you wish to remain anonymous)
By Phone
By E-mail
No Preferences, any medium is fine
1st Choice
2nd Choice
3rd Choice
Please briefly describe the nature of your consultation.
*
Your answer
Send me a copy of my responses.
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