{"id":58,"date":"2006-09-08T11:14:02","date_gmt":"2006-09-08T16:14:02","guid":{"rendered":"https:\/\/www.nicholls.edu\/counseling\/documents-and-forms\/"},"modified":"2025-09-05T20:50:57","modified_gmt":"2025-09-05T20:50:57","slug":"documents-and-forms","status":"publish","type":"page","link":"https:\/\/www.nicholls.edu\/counseling\/documents-and-forms\/","title":{"rendered":"Documents and Forms"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"58\" class=\"elementor elementor-58\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-5e950ce6 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"5e950ce6\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-2ff649b3\" data-id=\"2ff649b3\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7a500529 elementor-widget elementor-widget-text-editor\" data-id=\"7a500529\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><a href=\"https:\/\/www.nicholls.edu\/counseling\/wp-content\/uploads\/sites\/91\/2020\/04\/release_of_information.pdf\">Release of Information form<\/a><\/p><p><a href=\"https:\/\/www.nicholls.edu\/counseling\/wp-content\/uploads\/sites\/91\/2023\/01\/Declaration-of-Practices-Adrienne-Naquin-Bolton.pdf\">Declaration of Practice Adrienne Naquin Bolton<\/a><\/p><p><a href=\"https:\/\/www.nicholls.edu\/counseling\/wp-content\/uploads\/sites\/91\/2023\/01\/Declaration-of-Practices-for-Krystyn-K.-Dupree.pdf\">Declaration of Practices for Krystyn K. Dupree<\/a><\/p><p><a href=\"https:\/\/www.nicholls.edu\/counseling\/wp-content\/uploads\/sites\/91\/2023\/01\/Declaration-of-Practices-for-Elnora-Parker-Vicks.pdf\">Declaration of Practices for Elnora Parker Vicks<\/a><\/p><p><a href=\"https:\/\/www.nicholls.edu\/counseling\/wp-content\/uploads\/sites\/91\/2023\/01\/Declaration-of-Practices-for-Michael-J-Bourque.pdf\">Declaration of Practices for Michael J Bourque<\/a><\/p><p><a href=\"https:\/\/www.nicholls.edu\/counseling\/wp-content\/uploads\/sites\/91\/2023\/01\/Declaration-of-Practices-for-Randi-Gros.pdf\">Declaration of Practices for Randi Gros <\/a><\/p><p><span style=\"font-family: Arial, sans-serif\"><span style=\"--tw-scale-x: 1;--tw-scale-y: 1;--tw-scroll-snap-strictness: proximity;--tw-ring-offset-width: 0px;--tw-ring-offset-color: #fff;--tw-ring-offset-shadow: 0 0 #0000;--tw-ring-shadow: 0 0 #0000;--tw-shadow: 0 0 #0000;--tw-shadow-colored: 0 0 #0000;background-color: #ffffff\"><a href=\"https:\/\/bnpssb1.nicholls.edu:8444\/BannerExtensibility\/customPage\/page\/ACT157\">Authorization to Release Information in the Event of a Mental Health Crisis Form<\/a><\/span><\/span><br style=\"--tw-scale-x: 1;--tw-scale-y: 1;--tw-scroll-snap-strictness: proximity;--tw-ring-offset-width: 0px;--tw-ring-offset-color: #fff;--tw-ring-offset-shadow: 0 0 #0000;--tw-ring-shadow: 0 0 #0000;--tw-shadow: 0 0 #0000;--tw-shadow-colored: 0 0 #0000;font-family: Arial, sans-serif\" \/><em style=\"--tw-scale-x: 1;--tw-scale-y: 1;--tw-scroll-snap-strictness: proximity;--tw-ring-offset-width: 0px;--tw-ring-offset-color: #fff;--tw-ring-offset-shadow: 0 0 #0000;--tw-ring-shadow: 0 0 #0000;--tw-shadow: 0 0 #0000;--tw-shadow-colored: 0 0 #0000;font-size: 16px;font-weight: 400;font-family: Arial, sans-serif\">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.<\/em><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>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 FormIn compliance with Louisiana Act No. [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":0,"menu_order":9,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"default","site-content-layout":"default","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-58","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Documents and Forms - Counseling Center<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.nicholls.edu\/counseling\/documents-and-forms\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Documents and Forms - Counseling Center\" \/>\n<meta property=\"og:description\" content=\"Release of Information form Declaration of Practice Adrienne Naquin Bolton Declaration of Practices for Krystyn K. 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