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Forms

A Confidential Release of Information (71k .pdf) must be completed and returned to the Counseling Center if you want the center to reveal personal information about your care. This release specifies to whom and what type of information may be released; it’s not a “blanket” release. See Confidentiality for more information.

Psychiatric Consultation Questionnaire (228k pdf): Students wishing to be seen for a psychiatric consultation should complete this form prior to their first visit. See Psychiatric Consultations for more information.

A nutrition and fitness peer education internship is available to undergraduate or graduate students. Download the internship application (152k .doc). See Nutrition/Fitness Internship to learn more.

Males who wish to take a stand against sexual assault may with to complete the Sexual Assault Prevention Pledge Sheet (24kb .doc) and return the completed form to Dara Raboy-Picciano, LCSW-R. Read more about the 20:1 sexual assault prevention fraternity peer education program.

 


 

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Last Updated: 4/30/12