IMMACULATE CONCEPTION ACADEMY

GUIDANCE AND COUNSELING SERVICES

CONSENT FORM

This form is used to record consent for the school to collect information and to assist in
gathering student profiles or individual inventory.

Information gathered about each student is stored in a cumulative folder and can only be
access by the guidance officer and/ or the student’s adviser (specialist) in order to better
understanding them.

The guidance Office keeps an organized and systematic record of each student. All
personal information is kept strictly confidential.

The individual inventory collects the following data:

1. General information
2. Educational Background
3. Home Family Background
4. Interest and Hobbies
5. Personal- Social Adjustments

Consent I give consent for:

 guidance office to collect personal information for the purpose of information services
and;
 letting the guidance office share relevant personal information with student’s adviser
and/ or specialist, only if needed.

________________________________ _____________________
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Student Name Signature Date

________________________________ _____________________
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Parent Name Signature Date