Adverse childhood experiences (ACEs) are highly prevalent and considered a global public health crisis (Forgash, 2015). ACEs are associated with toxic stress resulting in severe impairment of the cardiovascular, endocrine, and immune systems (Asmussen et al., 2020). Consequently, the ten categories of ACEs have been linked to multiple risk factors for unhealthy behaviors and nine of the 10 leading causes of death in adults (Asmussen et al., 2020). A crucial component to mitigating the effects of ACEs is through identification of those exposed. Ideally, screening for ACEs occurs after the age of 18 years and prior to the onset of disease. Thus, the college setting is an opportune time to address ACEs given the prevalence of ACEs and the high rate of unhealthy behaviors occurring among college students (Karatekin, 2017). Many evidence-based practices have been established to address ACEs; however, there remains a gap in specific guidance for the student health setting. Therefore, a needs assessment was conducted to assess existing strengths and resources and identify needs for student health clinicians to address ACEs among college students. A two-phase mixed method design was utilized to obtain data from six clinicians at North Dakota State University Student Health Services clinic using an electronic survey, an informational guide, individual interviews, and a presentation of the results to stakeholders. Findings from the needs assessment informed best-practice recommendations for student health clinicians to address ACEs among college students. Recommendations include the following: 1) enhance clinician understanding of ACEs and trauma-informed care; 2) provide specific guidance for student health clinicians; 3) address barriers to utilizing the ACE screening tool; 4) incorporate the ACE screening tool in the student health setting; 5) identify students with ACEs based on ACE-associated symptoms; 6) assess risk for toxic stress; 7) develop therapeutic relationships; 8) provide evidence-based interventions to regulate the stress response; 9) assist in building resilience; 10) promote protective factors; 11) encourage positive coping mechanisms; 12) educate patients on ACEs, toxic stress, risk for ACE-associated health conditions, and signs of distress; 13) offer referrals as indicated.