The Informed Consent Statement is a document that advises students about FERPA compliance, relevant policies, state and federal laws, and rights. Examples of rights and policies include potential confidentiality limits with video conferencing, the policy on using a webcam, permission for administrators to access recorded information for the purpose of improving the services, and the agreement to having the session recorded.
The Consent Statement for your institution or district can be added in the Admin Settings by the ConexED Administrator. The statement can be written in either plain text or html.
A Consent Statement can also be added in the group’s Login Settings. Adding a Consent Statement here will override the institution’s statement when students interact with just that group.
If you draft an original statement or use one of the examples provided in this resource as a template, it is a best practice to work with the legal team at your institution to finalize the language, so it is appropriate for your specific school and particular students.
To [Name of School] students:
Please read the entire Informed Consent Statement below BEFORE using this system to access services. Please click on “I Agree” at the bottom if you wish to schedule an online appointment.
TERMS & CONDITIONS – Information about you is confidential. It is important that you supply the most current information about yourself, your educational history, plans, and career goals so that employees may provide you with the most accurate information specific to your needs.
To all current and prospective [Name of School] students. Below are the terms and conditions for using the Online Counseling Services at [Name of School]. Please read carefully and click the agree button below in order to move forward with online counseling.
I have read the above information in detail. I understand and agree to the Terms and Conditions established for [Name of School] Online Counseling Services.
To all current and prospective [Name of School] students, you must carefully read the entire “Terms & Conditions” and “Privacy Protection” statements below BEFORE using the [Name of School] appointment scheduling and online services. Be advised that by using the [Name of School] appointment scheduling and online services, you are confirming that you have read and agree to the “Terms & Conditions” and “Privacy Protection” statements.
Please take note that the Family Educational Rights and Privacy Act (FERPA) of 1974 is a federal law designed to protect the privacy aspects of a student’s educational record. It regulates the use and disclosure of personal information in educational records and permits a student to know what material is maintained in those records. For the purpose of providing in-person and online education and counseling services, student information will be collected and made available to school official(s) with legitimate educational interests, and student information may also be accessed by a ConexED technical administrator to facilitate your online education and counseling, with your consent. Please review the [Name of School] FERPA policy which can be found at this link: https://xxx
You can obtain more information about the Family Educational Rights and Privacy Act of 1974 through the U.S. Department of Education’s website: (https://www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html)
[Name of School] Policy XXX which governs Computer and Network Use may be found at this link: https://xxx
Please click the “agree” button below in order to move forward with requesting in-person and online services.
TERMS & CONDITIONS:
I affirm and acknowledge that I am a student enrolled at [Name of School] and I consent to the release of my education records to the counselors and staff employed by [Name of School District] ([Name of School]) for the purpose of providing online counseling services in connection with my academic program. I understand that education records include, but are not limited to, information about my academic standing, personally identifiable information, disciplinary issues, and financial obligations to [Name of School].
As used below, “I,” “you,” ”myself,” and other personal pronouns refer to the student. I agree to represent myself authentically in all aspects when participating in an in-person or online counseling session and/or student services or webinar.
[Name of School] is committed to protecting your privacy and personal information. No student education records or personally identifiable information is shared with outside entities, except those institutions to which you provide your information, or consent to have [Name of School] provide your information, including as specified in the Terms & Conditions above, and where required and/or authorized by law.
The online meeting sessions and/or webinars may be recorded.
Additionally, because of the real-time video and audio interactions that will be used for online meeting sessions and/or webinars, you should be aware that when you are logged onto the [Name of School] appointment scheduling and online services, depending on the placement, positioning, and angle of your communication device, [Name of School] online counselors and/or support staff likely will be able to view the area behind and around you, which may include areas of your home/location and other people and/or activities within the home/location. Additionally, for these same reasons, [Name of School] online counselors and/or support staff may also be able to hear what is going on in your surroundings. Thus [Name of School] cannot ensure and you should not expect either the confidentiality or privacy of any activities in your home/location during an online session.
When reviewing the Intake Form, please verify that the information about yourself, your educational history, academic plans and career goals is correct so that the counselor and/or support staff may provide you with the most accurate information specific to your educational objectives.
By clicking the “agree” button, I consent to the “Terms & Conditions” and “Privacy Protection” policy as described above.