Social Work Consent Form
East Prairie offers individual and group social work services to its students. Students may wish to see the social worker for a variety of reasons including but not limited to: concerns about self-esteem, coping skills, stress management skills, peer interactions, anger management, divorce/separation/loss, and social skills. Students may be referred to the school social worker by parents, teachers, staff, the principal, or self. Students can see the school social worker three (3) times without having a signed consent on file. Students who wish to see the social worker on an ongoing basis must have a signed consent on file.
All content within sessions is kept confidential with the exception of threats to hurt his/her self or someone else or if the student reports any form abuse. As a mandated reporter, I am required to report disclosures of abuse to the Department of Children and Family Services (DCFS).
Jamie Goodman, MSW
School Social Worker
I_______________________ give consent for _____________________________ to see the school social worker.