FORM CODE CF14-IFS

Calayan Educational Foundation, Inc. FORM NAME Informed Final Session

PREPARED BY Guidance Center
GUIDANCE CENTER REVISION NO. 0
EFFECTIVE DATE October 2023

INFORMED FINAL SESSION

Student Name: _____________________________________________Date: __________________

A. REASON FOR FINAL SESSION

● The session goal was completed.
● The student refused to receive or participate in services.
● The student transferred to other school.
● There was little or no progress in the session goal.
● This is a planned pause in session.
● The student needs professional services available outside the Guidance Center, and so was referred to:
______________________________________________________________________________________________
● Other: _____________________________________________________________________________

B. SOURCE OF INFORMED DECISION FOR FINAL SESSION

The decision for final session was made by:
● Student-initiated
● Parent
● Legal Guardian
● Other Family Members
● Outside Professional
● A mutual decision
● Other: _____________________________________________________________________________

C. KINDS OF SERVICES RENDERED

● Academic Counseling, for ______ sessions
● Personal Counseling, for ______ sessions
● Social Counseling, for ______ sessions
● Career Counseling, for ______ sessions
● Other: ______________________________________________________

D. SESSIONS
Referred on date: _________________ Date of first contact: ______________ Date of last session: ____________
Number of sessions: Scheduled: _______ Attended: ______ Cancelled: ______ Did not show: ________________

E. SESSION GOALS AND OUTCOMES

(Code outcomes as follows: N = no change, S = some or slight [about 25% to 35%], M = moderate [about 50%])
Goal Outcome___________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

This is to certify that I have spoken with the guidance counselor / associate concerning my final session and have
recognized the end of our counselee-counselor relationship as soon upon signing this form.

Signature over Name: __________________________________________ Date: ______________________

PARENT / GUARDIAN ACKNOWLEDGMENT

This is to certify that I have spoken and recommended with the guidance counselor / associate concerning my child’s
final session and have recognized the end of their counselee-counselor relationship as soon upon signing this form.

Signature over Name: __________________________________ Relationship: _____________________Date: ___________

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