Parental Consent to Participate in Services Form - GADOE



244792576200Parental Consent to Participate in Services FormThe Graduate Marietta Student Success Center (GMSSC) provides a number of services that have been requested specifically by the student body, this form provides your student access to all services.00Parental Consent to Participate in Services FormThe Graduate Marietta Student Success Center (GMSSC) provides a number of services that have been requested specifically by the student body, this form provides your student access to all services.354965-64135Student SuccessCenter00Student SuccessCenterYour child has requested to participate in one or more of the activities listed below within the GMSSC. The GMSSC was created based on student suggested topics of interest and requested services. Our mission is to provide wrap-around support services for our students in an effort to increase their ability to learn and graduate on time with their class. All three of the centers listed below are housed at Marietta High School. Center for Academic SupportCenter for Behavioral SupportCenter for Community Partnerships – Counseling and Family SupportAlternative SchedulingWriting Lab and Access to TechnologyStudy Skills, Time Management, OrganizationTutoring Services, during and after schoolMentoring ProgramsInformation regarding School Clubs and Academic Honor SocietiesCommunity Services OpportunitiesACT/SAT Voucher AssistanceTest Preparation – Accuplacer,ASVAB, ACT, SAT, GEDCollege Selections/Scholarship AssistanceCareer Shadowing/Internships/JobsYouScience AssessmentAccess to recruiters from all military branches, including National Guard and Reserves personnelPeer Mediation/Conflict ResolutionAnger Management SupportAlternative Suspension PlacementYoga ClassesMeditationBehavioral & Psychological TestingProbation ServicesAssistance in dealing with Bullying/Harassment Stress Release and Stress ManagementManaging Social MediaTeacher/Student MediationBuilding Healthy RelationshipsWellness and NutritionJob Skills AssistanceInterview SkillsResume WritingDress for SuccessProfessional EtiquetteEating DisordersHomelessnessGriefSexual AbuseSexual Identity/LGBTQiDepressionFamily Communication CounselingFamily Changes/DivorceDealing with Sexual ActivityTeen Parenting Skills AssistanceMental HealthSelf-EsteemGang ResistanceViolence at HomeCutting/Self-HarmSubstance AbuseSuicide PreventionPornographyCounseling for students in families struggling with substance abuse, incarceration, and concerns related to mental and physical healthFood PantryClothing ClosetI understand that by signing, I consent to my student participating in services at the GMSSC. I also understand that at any time I can revoke my consent by written, dated communication. If you have any concerns or questions regarding services provided within the GMSSC, you may contact the center directly at (678) 919-4500.________________________________ ____________________________________ Student Name (Printed) Date ________________________________ _____________________________________ Parent/Guardian Name (Printed) Parent/Guardian Signature_________________________________ ____________________________________ Signature of GMSSC Representative Date ................
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