Group Counseling Informed Consent for Parents

The school counseling program at North Lawndale College Prep High School offers short-term individual and group counseling to all students. Parents/guardians or school staff may refer students for counseling, or students may request counseling. North Lawndale College Prep continues to support Students in Temporary Living Situations (STLS) each year. The sophomore class at NLCP struggles with attendance and academic achievement rates, specifically the students who identify as STLS. NLCP seeks to improve these rates, however the NLCP staff recognize that STLS students may need additional support, resource, and encouragement for improvement. Within the class of 2016, current sophomores, 15 students identify as STLS and their average GPA is 1.92, making it .46 less than the total average sophomore GPA. In addition to academics, the sophomore STLS students have a 12.1% lower attendance rate than the sophomore class as a whole. The counselors and teachers of the sophomore class recognize that these STLS students would benefit greatly when offered additional resources. The Closing the Gap Group intends on delivering STLS students extra positive support and feelings of connectedness that will positively impact their academic performance and attendance rate at NLCP. There will be 2 groups consisting of 8 or less students whom all identify as STLS. Students will meet a total of 4 times this academic school year. In order to build trust with the students, we will keep information confidential, with some possible exceptions. Because these services are provided to minor students in the school setting, we understand that we may share information with parents/guardians, teachers, and/or administrators or school personnel who work with the students on a need to know basis, so that we may better assist the students as a team. We are also required by law to share information with parents or others in the event a student is in danger of harm to self harm to others or reports of abuse. The counselor will make the students aware of these limits to confidentiality and will inform the students when sharing information with others. If you would like me to share information with a third party, such as a community counselor, psychiatrist, social services worker, or pediatrician, you will need to sign an additional release of information form. As school counselors it is our responsibility to provide quality care to your student. In order to ensure that quality of care is being provided consultation with a colleague may be necessary. During this consultation, every effort will be taken to protect the identity of your student. I have read each of the following items and I understand the information that is contained in this document. I give my consent to the terms of this document and agree to enter into a counseling relationship. Students Signature_______________________________________ Date____________ Parent/ Guardians Signature______________________________ Date____________