Counseling center utilization patterns during a 2-year period for 218 international and 222 U.S. college students were examined. Significant between-group differences were found with regard to age, academic status, referral source, relationship status, self-reported concerns, counselor diagnosis, disposition, hospitalization rates, prior counseling experience, and use of crisis appointments. Significant within-group differences among international students were also found. Implications for improving programs and clinical services are discussed. (Contains 2 tables.)