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Counseling Intake Form

Welcome to the Counseling and College Success department at Madison College. We provide short-term academic, career, and personal counseling services for currently enrolled students. Benefits of counseling include:

  • better interpersonal relationships
  • improved academic performance
  • solutions to specific problems
  • increased resilience/lower stress

The counseling process includes some risks as you work through your concerns. You may experience some sadness, anger, guilt or frustration. If you have questions or concerns, you are encouraged to discuss them during your counseling meetings. In order for counseling to be effective, it is necessary for you to take an active role in the counseling meetings.

Counseling at Madison College is available at no cost to currently enrolled students. 

Students under the age of 18 years old need to obtain written consent from their parent or legal guardian in order participate in counseling services at Madison College.

Counseling services are brief in nature and focused on solutions to your main concerns. If we determine that your counseling needs require resources or competencies beyond what we can provide, we will assist you with a referral to an appropriate and affordable community-based mental health provider.

If you are referred to a provider off campus, you are responsible for their charges.


Services Not Provided:

We do not provide any mandated services or those that may require court testimony, letters, or reports to be filed related to any legal proceedings on behalf of the student. 

Couples or family counseling is not  offered at Madison College. If ongoing couples or family counseling is needed, we will assist you in finding a counselor in the community to meet your needs.

Record Storage:

  • Counseling records and individual documents are maintained electronically on our CRM, are password protected, and accessible by Counseling Services staff only. 
  • Student records will be kept for at least seven years after the date of the last contact with our department. 
  • Upon written request, we will provide access to your clinical records and/or a summary to another mental health professional or physician of your choice. 
  • If you request the release of this information, we may request personal contact with you prior to releasing the information.