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Book Appointment

The purpose of the following questions is to gather basic information our planning and practice in an effort to serve you better.

Required fields are marked with an asterisk (*)

Demographic Information





Must be a valid Nipissing University email address (

Current Concerns & Reasons for Seeking Support

Please rank the following areas (that apply) in order of most pressing/relevant (1) to least pressing/relevant (5). Please leave areas that are currently not of concern blank.


Please note that our team offer varying hours to best meet the needs of all NU students. As a result, we will do our best to meet your suggested appointment times; however, may need to offer alternatives to ensure timely and effective service.

Select a date from the calendar.  
Select a date from the calendar.  
Select a date from the calendar.  
Privacy Information


Protection of Privacy

The personal information on this form is collected under the authority of the Nipissing University Act, 1992. It is related directly to, and needed by the University to provide support services to students in the course of their studies while at Nipissing University. The information will be used only by Student Learning and Transitions employees and will not be disclosed to any third party without your consent. If you have any questions or concerns about the collection, use, and disclosure of this information, please contact Student Development and Services, Nipissing University, 100 College Drive, North Bay, ON, P1B 8L7, (705) 474-3450.​

Nipissing University
100 College Drive, Box 5002, North Bay, ON, Canada  P1B 8L7
Tel: 705.474.3450 | Fax: 705.474.1947 | TTY: 877.688.5507
Brantford Campus
50 Wellington St.
Brantford, ON, Canada N3T 2L6
Tel: 519.752.1524 | Fax: 519.752.8372

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