About this Form
Form number: 339-1
Last revised: November 2015
The school psychologist can provide counseling to students with permission from the parent or guardian. Many students improve their school performance and attitude towards school by taking part in counseling sessions. These sessions are not intended to replace the need for non-school based counseling services. Information disclosed by the student during counseling sessions is not typically revealed to anyone else, except under certain circumstances (for example, evidence that a student is a threat to themself, others, or property).
Please sign and have the student return this consent form. This consent for counseling is valid for one school year. Student participation in counseling is strictly voluntary and parent consent to provide counseling to the student may be withdrawn at any time. Parents/guardians are encouraged to contact the school psychologist to keep informed about their student’s progress.
For group counseling, see MCPS Form 339-2, Consent for Group Counseling.
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