Consent - Coping: Your Personal Toolbox

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Please complete this consent form to obtain an invitation link to our virtual counseling lesson.

Compass Counseling lessons address topics related to personal/social, academic and
college/career development. Our ultimate goal is to assist scholars with developing
awareness of interpersonal issues, to develop strategies and skills to positively impact their school
achievement and to increase appropriate social interaction skills.

Email *

Scholar First & Last Name *

Parent First & Last Name *

Scholar Grade Level *

6th Grade

7th Grade

8th Grade

9th Grade

10th Grade

11th Grade

12th Grade

Who will attend the lesson: *

Learning Coach only

Scholar only

Both Scholar and Learning Coach

Parental Informed Consent: Please select below to indicate if your scholar is able to participate in counseling workshops/presentations whereby sensitive or personal topics may be discussed. Permission may be withdrawn at any time with a written notification to the counseling department. *

Yes, I give permission for my scholar to attend counseling workshops/presentations.

No, I do not give my scholar permission to attend counseling workshops/presentations.

I am a scholar who's age is 18 years or older and parental consent is not required.

Required

Additional comments:

A copy of your responses will be emailed to the address you provided.

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