Dongbei University of Finance and Economics
Surrey International Institute
Global Institute of Management and Economics
Student Affairs Office
Student Counseling Center
Lijin Building, Room 238
Phone: 84710615
Email: counseling_center@163.com
DUFE, SII/GIME
Student Counseling Center
Policy and Procedure Manual
Page Page 2 of 34
Dongbei University of Finance and Economics
Surrey International Institute/Global Institute of Management and Economics
Student Affairs Office
Student Counseling Center
Policy and Procedure Manual
Welcome to the Dongbei University of Finance and Economics (DUFE), Surrey
International Institute (SII) Student Affairs Office’s Student Counseling Center. This Policy
and Procedure manual has two intended purposes. One purpose is for guidance in
provision of services through the Student Counseling Center. The other purpose is for
conducting the internal affairs of the Student Counseling Service. Sections within this
manual are listed below.
Table of Content
Description of the Student Counseling Center
Philosophy and the Mission of the Student Counseling Center
Structure of the Student Counseling Center
Who is eligible to access services of the Student Counseling Center?
Clinic hours
Referral Procedures:
Students
Faculty and staff
Scheduling and canceling appointments
Intake procedure
Students
Faculty and staff
Records
Confidentiality
Students – 18 and over
Students – under 18
Faculty and staff
Appendix
Appendix I: Referral Note
Appendix II: Student self referral
Appendix III: Counseling Agreement
Appendix IV: Intake Form
Appendix V: Case notes
Appendix VI: Parent authorization for psychotherapy (international students)
Appendix VII: International student waiver of privilege of confidentiality
Appendix VIII: Student’s Development Document of SII
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Description of the Student Counseling Center
The Student Counseling Center offers private confidential psychological consultation to the
students, faculty and staff of SII and GIME, as well as the faculty and staff of DUFE in either
English or Chinese. The psychological consultants of the Student Counseling Center is able to
provide a wide range of services for the treatment and prevention of those who suffer from
psychological and emotional distress.
The Student Counseling Center is located on the campus of DUFE, in Lijin Building, Room 238.
Visitors can expect to enter a private confidential hallway and waiting area. The Center consists
of two comfortably furnished consulting rooms that are structured to assure both auditory and
visual privacy. One room in the Counseling Center suite is used for office by the staff of the
counseling center.
Services to students:

Treatment services offered to students include:
o Individual psychotherapy (in English or Chinese)
o Couples therapy (in English only)
o Group therapy (in English only)
o Sand tray therapy (in English only)
o Clinical consultation (in English only)

Prevention services offered include psycho-educational workshops in both Chinese and
English on topics such as:
o Negotiating the first year of dorm life
o Managing stress
o Recognizing signs of anxiety and/or depression
o Acculturation – home sickness
Services offered to student support staff:

Individual consultation (in English only) to SII and GIME staff for guidance in
handling difficult student situations.
Services offered to Faculty and Staff of SII, GIME and DUFE

Confidential and private individual psychotherapy sessions (in English only)
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Policy and Procedure Manual
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Philosophy and the Mission of the Student Counseling Center
Surrey International Institute is committed to assuring the health and happiness of our students. Our
love for our students gives us pain to witness any student’s emotional suffering that interferes with their
life. The Student Counseling Center is established to facilitate the full development of student’s life
potentials unencumbered by emotional pain.
Mission of the Student Counseling Center is to serve the psychological and emotional needs of students
in SII and GIME who are experiencing emotional distress. Secondarily, provide psychological support for
faculty and staff of SII/GIME, as well as DUFE.
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Structure of the Student Counseling Center
The Student Counseling Center is organizationally located within the administrative unit of Student
Affairs Office for SII.
The Student Counseling Service personnel consists of one full-time clinical psychologist, one part time
Student Affairs Officer and a number of contracted psychologists and counselors on a fee for service
basis.
The Student Counseling Center is under the administrative umbrella of the Vice Dean/Party Secretary of
SII. The Vice Dean/Party Secretary holds responsibility for all administrative, and personnel portion of
the Student Counseling Office.
The full-time clinical psychologist is responsible for the clinical work of the Student Counseling Services.
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Who is eligible to access services of the Student Counseling Center?
The services of the Student Counseling Center are open, without charge, to:
 Student of SII and GIME
 Staff of SII and GIME
 Faculty of SII and GIME
 Faculty and staff of DUFE
For a nominal charge, services of the Student Counseling Center are open to:
 All students of DUFE
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Office opening and closing hours
The Student Counseling Center normal hours are:
Monday through Friday from 8:00 – 11:30 AM and from 1:00 - 5:00 PM
Appointments and activities outside of these times are available with prior arrangement during
the hours that the Lijin Building is open. Normally, the Lijin Building is open seven days a week
from 7:30 AM to 9:30 PM.
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Referral Procedures
Students
For SII students, access to services is available through multiple methods. For routine
appointments, students may contact the Student Counseling Center:
 by phone through the Student Counseling Center at 84710615
 By email at counseling_center@163.com
 Walk in to sign up for an appoint at Room 238, Lijin Building
For GIME students, access to services is available through multiple methods. For routine
appointments, students may contact the Student Counseling Center:
 by phone through the INTO office at 1865438 7588
 By email at Edward.chan@into.uk.com or at counseling_center@163.com
 Walk in to sign up for an appoint at Room 238, Lijin Building
Upon receipt of request for individual psychotherapy, the student will be sent an intake packet.
Upon return of the intake material, student will be connected by email with the most
appropriate consulting psychologist/counselor to schedule an appointment.
Faculty and Staff
For SII and GIME staff and faculty, as well as DUFE faculty, who wish an:
 Individual consultation, please email Dr. Tien directly at tien_l@dufe.edu.cn to
schedule an appointment
 Group in-service workshops, please email either counseling_center@163.com or
tien_l@dufe.edu.cn to schedule a workshop
SII emergency referrals
For emergency referrals, SII faculty or staff may call the Student Affairs Office at 84710615.
Someone in the Student Affairs Office will arrange for a member of the Student Counseling
Service to respond.
GIME emergency referrals
For emergency referrals, GIME faculty or staff may call the Student Services Manager of the
INTO office at 18624387566. Someone in the INTO Office will arrange for a member of the
Student Counseling Service to respond.
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Individual psychotherapy session appointments
The first individual psychotherapy session normally lasts for 90 minutes. This allows for fuller
exploration of the referral questions, problems and the goals for psychotherapy.
Follow up Individual psychotherapy session appointments
Follow up sessions are scheduled between the consultant and the consultee. Normally
subsequent sessions are 50 minutes in duration.
Cancelation of individual psychotherapy session appointments
SII Students: To schedule and/or cancel appointments for students who have had at least one
intake session at the Student Counseling Center, email counseling_center@163.com as soon as
possible. Someone from the Student Counseling Center will contact the appropriate counselor.
GIME Students: To schedule and/or cancel appointments for students who have had at least
one intake session at the Student Counseling Center, email Grace.gu@into.uk.com or
counseling_center@163.com as soon as possible. Someone from the Student Counseling
Center will contact the appropriate counselor.
Faculty/staff: To schedule and/or cancel appointments for faculty or staff who has had at least
one intake session, email tien_l@dufe.edu.cn as soon as possible.
Emergency access for existing clients of the Student Counseling Center
SII Students: Should a student who is an active consultee of the Student Counseling Center
experience a life threatening emergency such as feeling suicidal or homicidal, contact the
Student Affairs Office at 84710615.
GIME Students: Should a student who is an active consultee of the Student Counseling Center
experience a life threatening emergency such as feeling suicidal or homicidal, contact the INTO
office at Edward.chan@into.uk.com or call the INTO Student Services Manager at 18624387566
and contact GIME Student Services at languang@dufe.edu.cn or call at 15998449108.
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Student’s Intake procedure and assignment of cases
For students of SII and GIME
1. Student referral from all sources is sent to counseling_center@163.com
2. Referral packet is sent electronically to the student from the Counseling Center.
Referral packet includes:
a. Intake face sheet
b. Counseling agreement
c. Mini mental status exam
3. Paperwork is forwarded to the senior clinical psychologist. Case assignment is made
after the senior clinical psychologist reviews the mini-mental status exam.
4. The senior clinical psychologist communicates the case assignment to Counseling Center
staff. The Counseling Center staff notifies both student and the consultant of the case
assignment via email.
5. Consultant schedules appointment with the student according to both of their
availability.
6. All consultation occurs in one of the three offices located inside the Student Counseling
Center suite of offices.
7. Consultant emails Counseling_center@163.com notification of the appointment time to
assure availability of consulting rooms.
8. Counseling Center staff logs in the appointment time and creates the case file with the
following content:
a. Signed counseling agreement
b. Completed mini-mental status exam
c. Intake face sheet with statement of presenting problem
d. Any paperwork from the referral source
e. Blank case notes
9. Consultant picks up the case file in the locked file cabinet located in the Student
Counseling Center.
10. At the end of each session, consultant returns the case file to the ‘in-basket’ located in
the locked file cabinet with the completed case note for the session.
11. At the end of each session, consultant enters the contact information on the ‘weekly log
of activity’ form located inside the locked file cabinet in the office of the Student
Counseling Center.
12. Consultants who are contracted on a fee-for-service bases will be paid monthly based
on the ‘weekly log sheet’ and filed case notes.
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Faculty Intake procedure and assignment of cases
For faculty and staff of SII and GIME as well as faculty of DUFE
1) Contact Dr. Tien directly through email at tien_l@dufe.edu.dn to schedule appointment.
2) Dr. Tien will send email with the following accompanying paperwork:
a. Counseling agreement
b. Mini mental status exam
c. Intake face
3) Dr. Tien will create the case file and enter case notes directly into the file.
4) All faculty case files will be kept in confidential locked file cabinet in Dr. Tien’s office.
5) Access to the faculty case file is restricted to only Dr. Tien.
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Policy and Procedure Manual
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Records
Daily activities log
All case file will consist of the following items:
a. Intake face sheet
b. Counseling agreement
c. Mini mental status exam
d. Case note indicating
i. date of contact
ii. type of contact
1. phone
2. face-to-fact
3. email
iii. duration of contact
iv. Mental status
v. Suicidality
vi. Brief content of discussion
vii. Intervention
viii. Plan for next contact, if appropriate; or plan for case closure, if
appropriate.
e. Case Summary at the closure of the case
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Confidentiality – Students age 18 and above
All contacts for individual psychotherapy are confidential privileged communication between
the consultee and the consultant.
Confidentiality extents to the following information:
1) The fact that a person has sought and engaged in servicers at the Student Counseling
Center.
2) Subject content of all discussions between the consultee and the consultant.
3) Case records of the consultee
Exceptions to consultee’s confidentiality are:
1) At the written signed request of the consultee to a specific person.
2) At the written official notices from the government, or their designated officer.
3) When the consultant has reason to believe that the consultee is a danger to self of
danger to other, then the consultant will:
a. Contact Dr. Tien (or her designee) within 12 hours.
b. For SII students Dr. Tien, in collaboration with the consultant within 12 hours,
contacts
i. Dr. Lei
ii. The student’s Student Affairs Officer (in the case of a student)
1. The Student Affairs Officer, in consultation with Dr. Tien,
consultant and Dr. Lei will notify
2. Student’s guardian
c. For GIME student, Dr. Tien, in collaboration with the consultant within 12 hours,
contact
i. INTO office
1. INTO office, in consultation with Dr. Tien, and consultant will
notify student’s parents or legal guardian
4) In the case of an international student under the age of 18 who is supported by the
INTO office. See section for Consent and confidentiality for International students under
the age of 18.
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Policy and Procedure Manual
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Consent and confidentiality for International students under the age of 18
For international students under the age of 18, privilege of confidentiality is retained by the
parents or legal guardian. Information obtained either through individual psychotherapy
sessions and/or psycho-educational workshops are NOT confidential privileged communication
between the student consultee and the consultant.
The following information will be available to the parents and legal guardian of international
student under the age of 18:
1) The fact that a person has sought and engaged in servicers at the Student Counseling
Center.
2) Case records of the consultee
Exception to parents and legal guardian’s retention of privilege of confidentiality for
international students under the age of 18:
1. Prior to student’s enrollment in GIME, the INTO office will ascertain the parent’s or
legal guardian’s wish to retain privilege of confidentiality OR allow the student to
maintain privilege of confidentiality. See appendix VI: Parent Consent for Confidentiality.
2. If the parents or legal guardian has waived the privilege of confidentiality and the
international student under age of 18 contacts the Student Counseling Center for
services, the student will be asked to indicate their preference for the limits of
confidentiality in regards to contact with the student’s parents or legal guardian. See
appendix VII: International student waiver of privilege of confidentiality.
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Policy and Procedure Manual
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Confidentiality – Faculty and staff
All contacts for individual psychotherapy are confidential privileged communication between
the consultee and the consultant.
Confidentiality extents to the following information:
1. The fact that a person has sought and engaged in servicers at the Student Counseling
Center.
2. Subject content of all discussions between the consultee and the consultant.
3. Case records of the consultee
Exceptions to consultee’s confidentiality are:
4. At the written signed request of the consultee to a specific person.
5. When the consultant has reason to believe that the consultee is a danger to self of
danger to other, then the consultant will contact the consultee’s next of kin.
In the unlikely event that a written official notices from the government, or their designated
officer, request access to individual psychotherapy case record for a staff or a faculty member,
the Student Counseling Center senior clinical psychologist will:
6. Contact the faculty/staff member within 12 hours of receipt of the official written
request.
7. Faculty/staff member determine whether case records shall be released.
a. If the faculty/staff consent to the release of records, such consent will be noted
with a written signed authorization from the faculty/staff member.
b. If the faculty/staff does NOT consent to the release of records
i. An designated appoint time shall be set within 12 hours.
ii. At the designated appoint time, the faculty/staff shall witness the
shredding of their case record.
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Personnel listing
Dr. Tien Liang
Shang Xiao Ming
Consultants
Theo Cope
Sun Xiao Jie
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Appendix I: Referral Note from faculty or staff
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Student Counseling Center
REFERRAL NOTE
Referrer’s Name:
Referrer’s phone #:
______________
_____________
Date: ______________________
Referrer’s email: _______________________
Student’s Dept.: □SII □GIME
Student need counselor speaking □ English □Chinese
Student Name
Gender
Pin Yin Name
Class/Dept.
English Name
Student ID#
Student’s email
Student’s
phone
Reasons for Referral
Signature：
□Male □Female
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Appendix II: Student self referral
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Student Counseling Center
CLIENT SELF REPORT
To make it more effective, please email this information to conseling_center@163.com or call
84710615. The information will be kept strictly confidential. A counseling center staff will email
you to arrange for an appointment.
Name
Gender
□M □F Date of Birth
□SII □GIME
Pin Yin Name
Class/Dept.
English
Name
Only Child
Student ID#
□Yes □No
Lauguage
I refer a Consultant who can speak
□Chinese □English
Phone
Email
Appointment Date：
Time：
Consultant： □Dr. Tien Liang □ Dr. Theo Cope □Dr. Sun Xiaojie □Shang Xiaoming
English only
English only
Chinese
Chinese only
Problem (Describe your problem. Include some examples of what you are facing.)
Purpose (What do you want to gain from the counseling?)
Have you had consultation before?
□No
□Yes (Time:
Location:
Result:
)
Have you completed any questionare before?
□No □Yes (Time:
Questionare:
Result:
)
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Appendix III: Faculty and staff self referral
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Student Counseling Center
Faculty and Staff Self Request
To make it more effective, please email this information to tien_l@dufe.edu.cn or call 84710615.
The information will be kept strictly confidential. Dr. Tien will email you to arrange for an
appointment.
Name
Gender
□M □F Date of Birth
□SII □GIME
Pin Yin Name
Class/Dept.
English
Name
Phone
Language
I refer a Consultant who can speak
for consult □Chinese □English
Consultant： □Dr. Tien Liang □ Dr. Theo Cope □Dr. Sun Xiaojie □Shang Xiaoming
English only
English only
Chinese
Chinese only
Problem (Describe your problem. Include some examples of what you are facing.)
Email
Purpose (What do you want to gain from the counseling?)
Have you had consultation before?
□No
□Yes (Time:
Location:
Result:
)
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Appendix IV: Counseling Agreement
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Student Counseling Center
Counseling Agreement
Welcome to the DUFE-SII/GIME Student Counseling Center. The credentials of your counselor is
available for pick up in the entry way. We are committed to providing you the most confidential and
effective support and treatment available. It is the nature of the counseling process that in order to
achieve the best results, you need to tell us everything that is on your mind, even if it is uncomfortable
or embarrassing. If you have any questions about the counseling process or any aspect of your
experience with the counseling, please feel free to ask questions.
Confidentiality:
Please know that we will keep all information confidential. This means what you say in session with your
counselor, will not be repeated to anyone, except:
· If you give us your written permission.
· If you tell us you have a plan to kill yourself, kill someone else, or abuse a child. I will contact your
Student Affairs Officer and your guardian.
· From time to time, I may discuss your situation with another counselor for advice. If I do this, I will
not tell the other counselor your name or anything to identify who you are.
Appointments:
- The first office visit is scheduled for 90 minutes. Other office visits are normally scheduled for 50
minutes.
- The appointment is reserved for you. If you come late, we will end at the scheduled time so as not to
interfere with the next person’s appointment.
- In the case of illness, please call Student Affairs Office at 84710615 or email at
counseling_center@163.com as soon as possible. This enables us to contact your counselor to free up
his/her time for other appointments.
Complaints
If for any reason you are displeased with the services of the Student Counseling Center, please contact
tien_l@dufe.edu.cn
I have read, understand and agree to the above policies. I have discussed these policies with my
therapist and all questions have been answered to my satisfaction. I have been offered a copy of these
policies to take with me if I desire.
Client(s) Signature(s) ________________
Date: ______________
Therapist Signature: ________________
Date: ______________
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Appendix V: Intake
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Appendix VI: Case notes
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Student Counseling Center
CHART NOTE
Client’s Name:
Student ID #:
Date:
Pin Yin:
English:
Session #:
Time: Start
End
Notes of This Session
Situation
Mental Status: Record level of severity next to abnormal findings: 1=Mild, 2=Moderate, 3=Severe, X=Normal
General Observations
Appearance
Well □Groomed □Unkempt □Disheveled Stated □Age □Younger □Older
Eye Contact
□Average □Hostile □Mistrustful □Withdrawn □Preoccupied □Demanding
Activity
□Average □Agitated □Slowed
Speech
□Clear □Slurred □Rapid □Pressured □Perseveration □Clang
Thought Content
Delusions
□Grandiose □Persecutory □Somatic □Bizarre □Nihilistic □Religious
□None Reported
Other
□None Reported
Self-Abuse
□None Reported
Aggressive
□None Reported
Perception
Hallucinations
□None Reported
Other
□None Reported
□Autistic □Obsessional □Guarded □Phobic □Guilty □Ideas of Reference
□Preoccupied □Other:
□Suicidal (assess lethality if present):
□Intent □Plan □Self-mutilation
□Aggressiveness (assess lethality if present):
□Intent □Plan
□Auditory □Visual □Olfactory □Gustatory □Tactile
□Illusions □Depersonalization □Derealization
Thought Process
□Logical □Concrete □Incoherent □Circumstantial □Tangential □Loose □Racing
□Blocked □Flight of Ideas
Mood
□Euthymic □Euphoric □Anxious □Angry □Irritable □Depressed
Affect
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□Full □Constricted □Flat □Inappropriate □Labile
Behavior
□Cooperative □Resistant □Agitated □Impulsive □Over-Sedated □Assaultive□Restless □
Loss of Interests □Anthedonia □Withdrawn □Dystonia □Tardive Dyskinesia
Cognition
Impairment
□None Reported
Intelligence
□Estimate
□Orientation □Memory □Attention/Concentration □Ability to Abstract
□MR □Borderline □Average □Above Average
Assessment
Intervention
Plan
Consultant Signature：
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Appendix VII: Parent Consent for Confidentiality
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Parental or Legal Guardian Authorization for Psychological Services
Student Counseling Center
The Surrey International Institute and Global Institute of Management and Economics program
for international students provide mental health treatment through the Student Counseling
Center. Specific services available to international students include individual psychotherapy,
psycho-educational workshops, and consultation.
Individual psychotherapy sessions are confidential, including the fact that a student has chosen
to engage in psychotherapy. Please understand that you will not be notified should your child
elect to access individual psychotherapy. Exceptions to this policy of complete confidentiality
are:
-
Should your child become a danger to him/herself (suicide)
Should your child become a danger to others (homicide)
Should your child need psychiatric hospitalization
Should your child give the Student Counseling Center written permission to share
information with you.
If your child is under the age of 18, you may choose to retain parental right to access your
child’s records. Regardless of whether you choose to retain parental rights of access records,
you will be notified if any of the above exceptions to confidentiality occurs. Please indicate
your choice below:
I release my right to access my child’s psychotherapy records. I understand that I will be
notified if the above listed conditions exist.
_________________________________
Parent/legal guardian name
______________________
Date
I wish to retain rights to access my child’s psychotherapy records. I understand that I will be
notified when my child has chosen to engage in individual psychotherapy.
_________________________________
Parent/legal guardian name
______________________
Date
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Appendix VIII: International student waiver of privilege of confidentiality
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Student Counseling Center
International student’s waiver for privilege of confidentiality
Individuals under the age of 18 do not hold the privilege of confidentiality. This means, unless
your parent or legal guardian has waived their parental rights, the fact that you has chosen to
engage in psychotherapy will be communicated to your parents or legal guardian. The records
of your psychotherapy sessions are available to your parents or legal guardian at their request,
without consent from you.
In your case, your parent or legal guardian has waived their right to access this information.
This means the fact that you are engaged in psychotherapy, will be confidential. Your parents
or legal guardian will not be notified of your activities in the Student Counseling Center.
This form, when completed and signed by you, authorizes me to release specific information to
your parents or legal guardian.
I authorize the Student Counseling Center to release the following: (Please check as many as applicable.)
-
The fact that I am in individual psychotherapy
-
Case record of my individual psychotherapy sessions.
-
Other: ________________________________________________________________
I understand that my parents or legal guardian will be notified, regardless of this signed form, if I am
suicidal, homicidal, or in need of psychiatric hospitalization.
_________________________________
Signature
_________________________________
Please print your name
______________________
Date
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Appendix IX: Student’s Development Document of SII