The HUUSD uses Google forms to collect requests for private counseling. PROVIDERS (not parents) complete the forms; however, providers and parents must agree to the terms stated below.

Do not begin a form until you have read ALL INSTRUCTIONS and understand the process. All required documents MUST be uploaded into the form BEFORE clicking Submit.

Providers follow the same process to provide private counseling or therapy services at the school OR remotely with one exception. Remote providers do NOT have to complete/upload a fingerprint clearance.

Services WILL NOT begin until the Superintendent has approved the request.

PROVIDER AND PARENT AGREEMENT:

• These services are not part of a student's educational program. They are privately provided by the parent, and the parent is responsible for all costs associated with their provision.
• The school district is merely approving the use of space at the school. The parent(s) and provider will abide by the school’s facility use agreement, found at huusd.org. The school will waive all use fees.
• The school assumes no responsibility or liability for providing these private sessions.
• The private provider will abide by all rules, regulations, and laws of confidentiality related to the access of all other students and faculty—and the environment as a whole.
• The private provider will abide by all federal legislation regarding FERPA and HIPAA.
• It is the parent’s responsibility to manage all scheduling agreements with the provider and the school, including cancellations and rescheduling.
• The private provider will only use the space provided for the direct 1-1 service he/she is hired by the parent to provide and the adult restrooms. A private provider is prohibited access to other students (even with a student’s permission), faculty, and other classrooms and/or other school environments.
• The private provider must notify the Superintendent of Schools within 24 hours if at any time the provider:
  • Is charged with a misdemeanor or felony.
  • Has conditions issued on a license.
  • Has a suspended or revoked license.
  • Has been reported to the Department of Children and Families (DCF).

INSTRUCTIONS FOR COMPLETING THE FORM:

Providers complete this request to provide private counseling or therapy services at the school OR remotely. The process is the same.

1. Provider collects a signed statement from the parent consenting to services.
   • Click here for the template. Make a copy.
2. Provider clicks on the Google form for the school in which you wish to provide services.
   • See Quicklinks, top right. 
3. Provider uploads required files in the form.
   • See upload directions in the form.
   • ALL providers must upload the signed statement--which can be signed electronically. (Please name file as follows: Parentlastname_signed_statement)
   • Providers not currently contracted with the HUUSD must also upload copies of their license, insurance, and fingerprint clearance. (Please name files as Providerlastname_license, etc.)
     • Remote providers only need to upload copies of their license and insurance.
4. Provider submits the form.
   • This may take a few seconds.
5. Central Office notifies Building administrator/designee that services can begin, which will be AFTER Superintendent approval.
6. Building administrator/designee notifies the provider.

Contact Shannon Wisdom with questions about completing the form: [email protected].