<% recaptcha_challenge_field = Request("recaptcha_challenge_field") recaptcha_response_field = Request("recaptcha_response_field") recaptcha_public_key = "6LeGcbwSAAAAAJUgFCD9KejrRVQC66lFyPppMD7T" ' your public key recaptcha_private_key = "6LeGcbwSAAAAAB8jQkMMaoRtgs8qRk0pTMVGSwzY" ' your private key ' returns the HTML for the widget function recaptcha_challenge_writer() recaptcha_challenge_writer = "" & _ "" & _ "" end function ' returns "" if correct, otherwise it returns the error response function recaptcha_confirm(rechallenge,reresponse) Dim VarString VarString = _ "privatekey=" & recaptcha_private_key & _ "&remoteip=" & Request.ServerVariables("REMOTE_ADDR") & _ "&challenge=" & rechallenge & _ "&response=" & reresponse Dim objXmlHttp Set objXmlHttp = Server.CreateObject("Msxml2.ServerXMLHTTP") objXmlHttp.open "POST", "http://www.google.com/recaptcha/api/verify", False objXmlHttp.setRequestHeader "Content-Type", "application/x-www-form-urlencoded" objXmlHttp.send VarString Dim ResponseString ResponseString = split(objXmlHttp.responseText, vblf) Set objXmlHttp = Nothing if ResponseString(0) = "true" then 'They answered correctly recaptcha_confirm = "" else 'They answered incorrectly recaptcha_confirm = ResponseString(1) end if end function server_response = "" newCaptcha = True if (recaptcha_challenge_field <> "" or recaptcha_response_field <> "") then server_response = recaptcha_confirm(recaptcha_challenge_field, recaptcha_response_field) newCaptcha = False end if %> Counseling Needs Assessment for Lincoln Memorial University Students
Academics

Counseling Needs Assessment for Lincoln Memorial University Students



The Counseling Department would like to know your needs as a student. Please recognize that the list of concerns is not comprehensive, only a sampling of potential issues you as a student may be dealing with. Please fill out and submit the form below. Once the form has been submitted, and if you have requested services, you will be contacted by the counseling office.

CONFIDENTIALITY STATEMENT



Office of Counseling Services

Confidentiality and trust are imperative to the counseling process. Therefore, except as required by law, university policy and professional practice guidelines, the information shared during counseling and the identity of a student will not be shared with anyone outside the Counseling Office without the student's express written consent. This confidentiality generally extends to situations in which a student is referred to the Counseling Office by a faculty member, administrator, parent or friend. Situations requiring exceptions to confidentiality occur very infrequently and they are reviewed with students seeking services prior to beginning the counseling process. If you have any questions or concerns, you are encouraged to discuss them with the Director of Counseling. Counseling Services are located in Duke Hall, room 201. You can reach Jason Kishpaugh by phone at: 423.869.6401 or 800.325.0900, ext. 6401, or by email at Jason.kishpaugh@lmunet.edu . <% if server_response <> "" or newCaptcha then %> <% if newCaptcha = False then %> <% response.write("

Captcha response invalid. Please resubmit the form.

") %> <% end if %>
  • I. Please regard the following list of potential counseling issues.

    As a student, I would like help with the following issues:
    • 1. Thoughts of harming others 
    • 2. Thoughts of harming self 
    • 3. Time Management 
    • 4. Test taking/Test anxiety 
    • 5. Study Habits 
    • 6. Procrastination 
    • 7. Motivation 
    • 8. Grades/Probation 
    • 9. Instructor relationship 
    • 10. Friends/Roommate relationship 
    • 11. Family relationship 
    • 12. Employer relationship 
    • 13. Love partner relationship 
    • 14. Choosing a career 
    • 15. Choosing a major 
    • 16. Sexuality/sexual orientation 
    • 17. Meeting people 
    • 18. Grief 
    • 19. Financial Matters  
    • 20. Expressing feelings 
    • 21. Eating Problems 
    • 22. Assertiveness 
    • 23. Appearance/Weight 
    • 24. Alcohol/Drugs  
    • 25. Anger Management
  •      
  • II. From the list above, place the numbers of the five most important topics for you in the spaces below in order from most to least.


    • 1. (Most)

      2.

      3.

      4.



      5. (Least)

  •  
  • III. What are some other ways in which the counselors can help you?

  •  
  • IV. What is the best way to contact you? What is the best time? Please leave your information below.

  • Please provide an email address for us to contact you by:



  • *Fields are required <%=recaptcha_challenge_writer()%>

  •    
<% else %> <% 'Using CDOsys with Basic authentication in Classic ASP 'Original Author: Unknown 'Heavily Modified by: Joshua Cantrell 'Last Revision Date: 07-30-2009 'If authentication is enabled, it requires access to a mailbox on your account. 'reports 'mailFailed' - true or false 'and 'strErr' - Mail server error response 'and 'strErrCode' - Mail server numerical error response (as string) 'currently disabled 'dimension all variables (essential if 'option expicit' used) dim strHost, strErr, mailFailed dim strBody, strName, strMail dim strSubject, strFrom, strTo, strCC, strBCC, strReplyTo dim strAutoMailbox, strEmPass, ix dim fieldName, fieldValue, intFields Dim strLeft, strRedir, strRedirect Dim strNoprint 'modify for yourDomain ********************************************* 'your mail server strHost = "10.10.1.11" 'address of your outgoing mailbox 'this will appear in the headers as the originating mailbox 'strAutoMailbox = "formmail@ourarea.com" 'password for your AutoMailbox 'strEmPass = "1234" 'the name and email that appears in the "From:" line (can be different to above) 'strFrom = strName & "<" & strMail & ">" 'where to send the mail 'strTo = "janette.martin@lmunet.edu" strTo = Request.Form("zz_form_to") strTo = strTo & "@lmunet.edu" 'set the redirect variable strRedir = Request.Form("zz_redirect_to") if strRedir = "dcom" Then strRedirect = "http://www.lmunet.edu/dcom/thanks.shtml" elseif strRedir = "lmu" Then strRedirect = "http://www.lmunet.edu/thanks.shtml" end if 'where to send copies (optional) strCC = "" strBCC = "" '********************************************************************** 'collect details from the form *************************** strName = Request.Form("Name") strMail = Request.Form("Email") if strMail = "" Then strMail = "webmaster@lmunet.edu" end if 'create the "Reply To:" i.e. the name and email of the form user strFrom = strName & "<" & strMail & ">" strReplyTo = strName & "<" & strMail & ">" 'create subject string strSubject = Request.Form("zz_form_subject") 'create Body string strBody = strBody & "***************************************************" & vbCrLf 'This method will result in an unsorted form 'I left it here for reference only 'To enable it, add x to the variable list above 'and uncomment. 'For Each x In Request.Form 'strBody = strBody & x & ": " & Request.Form(x) & vbcrLf 'Next 'This method induces a count to sort the form based on 'the order of the form elements in the HTML strLeft = Left(fieldName,2) strLeft = lcase(strLeft) For ix = 1 to Request.Form.Count fieldName = Request.Form.Key(ix) fieldValue = Request.Form.Item(ix) strLeft = Left(fieldName,2) strLeft = lcase(strLeft) if strLeft <> "zz" then if lcase(fieldValue) <> "submit" then strBody = strBody & fieldName & ": " & fieldValue & vbcrLf & vbcrLf end if end if Next 'Adds the referring page and the IP details of sender to the mail body (optional) strBody = strBody & "Requested from " & Request.ServerVariables("http_referer") & vbCrLf strBody = strBody & "Requested by " & Request.ServerVariables("REMOTE_ADDR") _ & " at " & Request.ServerVariables("REMOTE_HOST") _ & ". Server time: " & time & " " & Date & " " & vbcrlf 'note the '_' continuation character, if spreading code to the next line for readability 'send the mail ************************************************** ******* 'initialise the error response string strErr = "" 'Const cdoBasic = 1 'Use basic (clear-text) authentication. Const cdoSendUsingPort = 2 Dim iMsg Dim iConf Dim Flds Dim sMsg On Error Resume Next set iMsg = CreateObject("CDO.Message") set iConf = CreateObject("CDO.Configuration") Set Flds = iConf.Fields With Flds '.Item("http://schemas.microsoft.com/cdo/configuration/smtpauthenticate") = cdoBasic '.Item("http://schemas.microsoft.com/cdo/configuration/sendusername") = strAutoMailbox '.Item("http://schemas.microsoft.com/cdo/configuration/sendpassword") = strEmPass .Item("http://schemas.microsoft.com/cdo/configuration/sendusing") = cdoSendUsingPort .Item("http://schemas.microsoft.com/cdo/configuration/smtpserver") = strHost .Item("http://schemas.microsoft.com/cdo/configuration/smtpconnectiontimeout") = 100 .Update End With With iMsg Set .Configuration = iConf .To = strTo 'To .From = strFrom 'From: if strReplyTo <> "" then .ReplyTo = strReplyTo 'add ReplyTo: if exists end if if strCC <> "" then .CC = strCC 'add CC if exists end if if strBCC <> "" then .BCC = strBCC 'add BCC if exists end if .Subject = strSubject 'add the subject .TextBody = strBody 'add the body (this is plain text) .Send 'send the mail strErr = Err.description 'response (empty if no problems) 'note: Err.number was not available when tested live End With 'clean up Set iMsg = Nothing Set iConf = Nothing Set Flds = Nothing 'prepare report flag and string if strErr = "" then mailFailed = false strErr = "Your mail has been sent." else mailFailed = true end if %> <% 'report result 'response.write (strErr) Response.Redirect "http://www.lmunet.edu/thanks.shtml" %> <%end if%>