UCC Registration Form

Welcome

UCC Registration Form

Thank you for contacting the University Counselling Centre (UCC).

Please complete the questionnaire in full and as accurately as possible. Your honest responses will help our team identify the right support for you.

Before proceeding, please note:

To access our services independently, you must be at least 18 years old. If you are under 18, please request parental consent before proceeding.
All information is kept strictly confidential in accordance with UCC's confidentiality policy.
In situations where your safety is at risk, UCC staff may need to take necessary steps — this will be discussed with you.

⚠️ If you are in immediate danger, please call 995 (SCDF/Police) or go to the nearest A&E immediately. For crisis support: SOS 24-hour helpline: 1767.

Section 1 of 4

Personal Details

Please provide your details exactly as they appear on your NTU matriculation card.

Full Name (as per matric card) *

Please enter your full name.

NTU Matriculation Number * Format: 1 letter + 7 digits + 1 letter (e.g. U2312345A)

Please enter a valid matric number (e.g. U2312345A — 1 letter, 7 digits, 1 letter).

Date of Birth *

Please enter a valid date of birth. Must be between 1940 and at least 15 years ago.

Gender *

Please select your gender.

Contact Number *

Please enter a valid contact number.

NTU Email Address * Please use your NTU email ending in @e.ntu.edu.sg or @ntu.edu.sg

Please enter a valid NTU email address (must end in @e.ntu.edu.sg or @ntu.edu.sg).

School / Faculty *

Please select your school.

Level of Study *

Please select your level of study.

Year of Study *

Please select your year of study.

Emergency Contact Details

We will only contact this person if your safety has been assessed to be at-risk, or if we are unable to reach you. This should be a next of kin or legal guardian.

Name *

Please enter emergency contact name.

Contact Number *

Please enter a valid contact number.

Relationship *

Please enter relationship.

Section 2 of 4

Your Concerns & Referral

Help us understand what brings you to UCC today so we can offer the best support.

How did you hear about / who referred you to UCC? *

Please select a referral source.

Please share with us your challenges: *

0 / 1000

Please share your challenges.

Please share with us how you have coped with it:

0 / 1000

Goals you would like to work on in session:

0 / 1000

Have you seen a mental health practitioner previously? *

Yes – Please state where and when: No

Please indicate if you have seen a mental health practitioner.

Your availability for appointment booking * UCC Hours: Mon–Thu 8.30am–5.45pm (last session 5.30pm), Fri 8.30am–5.15pm (last session 5.00pm)

Please share your availability.

Section 3 of 4

Mood Questionnaire

The following questions help us understand your mood over the past week. There are no right or wrong answers.

Please rate the extent to which each statement applied to you over the past week.
0 = Did not apply to me at all · 1 = Applied to some degree, some of the time
2 = Applied to a considerable degree / good part of the time · 3 = Applied very much / most of the time

0
Not at all

1
Some degree

2
Considerable

3
Very much

Please answer all 21 items before continuing.

Section 4 of 4

Safety Assessment

The following questions assess for safety. There are no right or wrong answers. Please answer as honestly as possible — this helps us provide the right support.

If you are in immediate crisis, please call SOS at 1767 or Samaritans of Singapore at 1800-221-4444.

Have you ever thought about or attempted to kill yourself? *

Never It was just a brief passing thought I have had a plan at least once to kill myself but did not try to do it I have had a plan at least once to kill myself and really wanted to die I have attempted to kill myself, but did not want to die I have attempted to kill myself, and really hoped to die

Please select a response.

How often have you thought about killing yourself in the past year? *

Please select a response.

Have you ever told someone that you were going to commit suicide, or that you might do it? *

No Yes, at one time, but did not really want to die Yes, at one time, and really wanted to die Yes, more than once, but did not want to do it Yes, more than once, and really wanted to do it

Please select a response.

How likely is it that you will attempt suicide someday? *

Please select a response.

Final Step

Consent & Submission

Please review and acknowledge our confidentiality policy before submitting.

Registration Submitted

Thank you for completing the UCC Registration Form. Our team will review your responses and contact you at your provided email or number to arrange an appointment. 💙

If you need immediate support, please call SOS at 1767 or go to the nearest A&E.