Make an Appointment with the Center for Advocacy, Prevention & Education (CAPE) Survivor Advocacy Team
Please fill out this confidential form to schedule a non-urgent appointment with a confidential CAPE advocate. CAPE Advocates will contact you as soon as possible during business hours to confirm your appointment, and can meet with you in-person, via zoom, or over the phone as you prefer.
Sign in to Google to save your progress. Learn more
If you would like to speak to an advocate immediately:
Monday-Friday 9AM-5PM: Please call our CAPE Survivor Advocacy line at (541) 737-2030
After-hours: Please call our Corvallis community partner, CARDV Crisis Line at (541) 754-0110
To reach the National Domestic Violence Hotline, call 800-799-7233
To reach the National Sexual Assault Hotline, call 800-656-4673
If you have an emergency, or feel you are in immediate danger:
If you have an emergency or feel that you may be in immediate danger, please call 911. 
For emergency advocacy support, call our Corvallis community partner, CARDV, at their crisis line at (541) 754-0110.
If you have experienced a sexual assault within the last five days:
Sarah's Place provides confidential and free medical support and exams for survivors of sexual assault. 
Call 541-812-4420 to speak with a SANE Nurse about their services. If you need immediate help, go to the Samaritan Albany General Hospital emergency room and request a visit with Sarah’s Place.
Name
Pronouns
Do you prefer contact by phone or email?
Clear selection
Phone Number
Email
Can we leave a voicemail?
Clear selection
Can we email you?
Clear selection
I would like resources relating to:
I would like to discuss something that happened...
Appointment Day/Time Availability
Appointment Type Preference 
Clear selection
If comfortable, please share your relationship to OSU:
If comfortable, please share what City/State/Country you're currently located in. 

This will help our advocates provide local resources in addition to our services through CAPE Advocacy.
Please feel free to let us know below if you have specific preferences related to the identities held by the advocate you will be working with. 

Please note that we may not have advocates that fit all of your preferences, but we try our best to match you with your most preferred.
Optional Additional Information
Thank you for taking the time to share your information with us. 
We strive to respond within 24 hours of receiving your form. Forms that are received after hours and on weekends will be responded to following business day. Our office is open Monday-Friday, 8am-5pm. 
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Oregon State University. Report Abuse