Rogue Community College
Rogue Community College
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Counseling Forms

Consent to Tele-Health
Informed Consent for Student Counseling Services
Counseling Intake Form
Informed Consent to AVR Counseling Sessions
Informed Consent to AVR EMDR Counseling Sessions
Authorization for Release of Information
Self-Management Plan

Before your first counseling session, please review and sign the first three forms (Consent to Tele-Health, Informed Consent for Student Counseling Services, and Counseling Intake Form) on this page. When you click on the link you will be prompted to log in to a secure platform using your RCC student ID and password. Only the Counseling department will have access to these completed forms, so you can rest assured that your information will remain confidential. You counselor will go over the forms with you during your first session. Please feel free to ask any questions that you have about the information on these forms.

If you would like to get in touch with your counselor, please click on their name below, which will open an email to them.

Eva Akiyama

Makiko Barrey

Julia Fisher

Shaylee Graham

Michelle Gray

Celeste Hettman

Shelly Hohl

Tom Pike

Nicholas Walker