Informed+Consent-Group+A

Consent-Group A

Harold Fortunato, Irene Vickner, Amy Huber, Robin Shelton, Linda Gardner, and Angel Castro

**Informed Consent School Counseling Services**

**(**//Please read this Informed Consent State before meeting with your counselor. After you meet with the counselor, please discuss any questions or concerns you have before signing this form.)//

**Introduction** The Universal High School is committed to providing quality education to all students. In an effort to achieve this goal parents/legal guardians and the school staff may refer students for counseling. The students may also request counseling for themselves. The main focus of the counseling program is to assist students in understanding how to make good choices that would help them to function properly in the world they live in, and become productive members of our society.

The counseling department includes (6) licensed professional school counselors with a certification from an accredited university. The school counseling department follows the guidelines from the ASCA, and all counselors are licensed under the Virginia Department of Education.
 * Background**

The Counseling Department provides brief, solution-focused counseling services to assist students with personal, social, academic, and career needs. The service you may receive is based upon a determination of your needs and goals, and the department’s resources. If the Counseling Department is not able to help you, proper referral sources will be identified for you. The Counseling Department adheres to Federal and State laws and ethical standards for all clients. The information is held in confidence unless your written permission is given. Every effort will be made to protect student and parent privacy rights except under certain limited conditions. These conditions generally include safety issues, legal issues, and professional responsibilities. Federal and State laws require that health and counseling professionals report certain situations. These include a reasonable suspicion of past or current child, elder, or dependent adult abuse, a danger to self, others, or property. A confidential counseling record is maintained with access to the school counselor and an authorized personal, and they may only be released when mandated by court or your signature. The benefits from counseling may include (a) improved ability to handle academics; (b) enhanced personal development; (c) improved interpersonal relationships. The risk from counseling may include remembering unpleasant events that could arouse strong feelings.
 * Eligibility and Services Limits**
 * Confidentiality**
 * Benefits and Risk**

**Consent Agreement**

**//I have read the above conditions for this counseling consent form. I accept these conditions and give my consent to be counseled by this professional counseling department. I have had the opportunity to discuss this information with my school counselor.//**

Client’s Signature __­­­­__Date __­­­­­­­­­­­­­­­__ Parent/Guardian’s Signature Date (If client is a Minor) I have discussed and explained the above information with the client. Counselor’s Signature Date