Faculty walking through campus

Counseling Records Release Form

Student Name: 

Date of Birth: 

W Number: 

Email Address: 

Cell Phone Number: 

Are you a current student?: 

          

 

Starting year at Wofford or graduation year if you have already graduated: 

Full Name while attending Wofford: 

I authorize the Counseling Center to:

  1.  
  2.  

 

Please include the name, address, and phone number if you are requesting information be given to an off campus party. If listing a professor or college employee, please include their full name.

 

The following information pertaining to myself:

for the purpose of: