Forms

Notice of Privacy Practices
This document describes how your counseling information may be used and/or disclosed, and how you can access your counseling information.

Retroactive Withdrawal Application for Degree Students
Use this form to apply for a withdrawal for a semester that has been completed.

Parental or Legal Guardian Consent for Treatment of Student Under 18 Years Old
This form is for parents or guardians whose students are under the age of 18. Complete this form in order to authorize medical and/or psychological services for a student.

Authorization for Release of Counseling Center Records
This form is for individuals who want to give written authorization for the release of their Counseling Center records to others.

Health Provider Letter
This letter is for medical providers to make a recommendation about a student’s academic withdrawal.

Appeal for No-Show Appointment
If you believe that we charged you in error for a no-show or late cancellation please complete this form and return it to the Counseling Center

Application for Training
Prospective interns and practicum students should complete this application form as part of their application processes.