Counseling Center

AT NICHOLLS STATE UNIVERSITY

Documents and Forms

Release of Information form

Declaration of Practice Adrienne Naquin Bolton

Declaration of Practices for Krystyn K. Dupree

Declaration of Practices for Elnora Parker Vicks

Declaration of Practices for Michael J Bourque

Declaration of Practices for Randi Gros

Authorization to Release Information in the Event of a Mental Health Crisis Form
In compliance with Louisiana Act No. 157 (R.S. 17:3138.1), Nicholls State University gives all enrolled students the opportunity to complete a voluntary mental health privacy authorization form. This form allows students to identify trusted individuals with whom the university may share important health information if a mental health crisis arises. Our goal is to ensure students receive the support they need.

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