Communities In Schools of South Central Texas, Inc.

 

CONFIDENTIALITY STATEMENT

 

 

 

As an approved CIS intern, part-time staff person, or volunteer, I agree to the following Commitment to Confidentiality:

 

In this capacity, I will use my professional judgment when interacting with a student, family member, or school staff member in the best interest of each student.

 

I understand that any written records or verbal information pertaining to students and their families are confidential.

 

I understand that, while participating in this program, I will come in contact with certain information which will be confidential in nature.

 

Other than to provide the university with de-identified case information regarding specific services provided, I will not reveal personal information gained from any written or verbal client contacts.

 

 

 

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Signature of Social Work Intern/Volunteer/Part-time Staff                                  Date

 

 

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Date of Birth