Consent for MU Counseling Center to Release Information to MU Title IX Office

Consent for Marshall University Counseling Center to Release Information to Marshall University Title IX Office

This form authorizes the Marshall University Counseling Center to share limited information with the Title IX Office regarding a student’s attendance in counseling sessions. This disclosure is made solely for the purpose of supporting the student through the Title IX process, including monitoring and implementing supportive measures. By signing this form, the student consents to the release of information confirming whether they are attending counseling. No details about the content of counseling sessions will be disclosed. This consent is valid for one (1) year from the date of signature and may be revoked at any time in writing.

Information about You

Your Name(Required)

First Middle Last

Student ID Number(Required)

Provide your Marshall University ID Number.

Preferred Name / Pronouns(Required)

List your preferred name and pronouns.

Date of Birth(Required)

Purpose of Disclosure: To assist the Title IX Office in implementing and monitoring supportive measures and/or accommodations related to a Title IX matter.

Recipient of Information: Marshall University Title IX Office.

This consent is valid for one (1) year from the date of signature unless revoked in writing earlier. I understand that I may revoke this consent at any time by submitting a written request to the Title IX Office, except to the extent that action has already been taken in reliance on this consent.

Your Name(Required)

First Middle Last

Thank you for completing the Consent to Release Information form, authorizing the Marshall University Counseling Center to confirm your attendance in counseling sessions with the Title IX Office. This consent helps ensure that appropriate supportive measures can be implemented and monitored as part of the Title IX process. If you have any questions or concerns about this form or your rights under FERPA, please contact the Title IX Office.

Important Update: Online Reporting Transition

Beginning Oct. 27, 2025:

The Title IX Office will move to an online-only reporting system. This change reflects a growing trend among Title IX offices nationwide and is designed to help us better serve our campus community.

Our goal is to ensure that Title IX reports are reviewed promptly and thoroughly. In-person and phone submissions, while often well-intentioned, can sometimes involve complex concerns that fall outside the scope of Title IX. These conversations, though important, can require significant time and follow-up, which may delay our ability to respond to Title IX matters with the urgency they deserve.

By centralizing reports through our secure online system, we can more efficiently triage concerns, prioritize Title IX cases, and maintain a consistent and equitable response process for all students, faculty, and staff.

Submit an Online Title IX Report

Please note: Due to staff availability, it may take up to five business days for your report to be reviewed.

If you are in crisis, please call 911 or contact the Marshall University Counseling Center for immediate support:
Prichard Hall, First Floor
304-696-3111
Counseling Center

We appreciate your understanding and remain committed to supporting a safe, respectful, and inclusive campus environment.