University of Louisiana at Monroe
Counseling Center
PERMISSION TO RELEASE INFORMATION
I give my permission to the ULM Counseling Center to release special need information to Residential Life for the:
This information is for professional purposes only and is confidential in nature.
_ _ _ __ __ __ _ _ __ | |__ | |_ (_) \ \/ / / _` | | '_ \ | '_ \ | __| | | \ / | (_| | | | | | | | | | | |_ | | / \ \__, | |_| |_| |_| |_| \__| _/ | /_/\_\ |___/ |__/