Forms and Policies

This page contains many of the documents and forms required to release information, request immunization records, return from medical leave of absence, and so forth.

Forms:

Release of Information Form

An authorization to release medical or mental health records.

Birth Control Order Form

Order Form to request refills of birth control pills.

Minor Consent to Treatment Form

An authorization from parent or legal guardian allowing SHAC to treat students under 18 years of age.

Immunization Record Request Form

To request immunization records be released to a 3rd party or to the student after graduation. Student health records are retained for 8 years after graduation.

Conscientious or Religious Exemption Form

For use if unable to meet required immunizations due to conscientious or religious belief.

Mental Health - Medical Leave of Absence Return Questions 

A form used for an off-campus mental health provider (therapist, psychiatrist) to relay mental health information regarding a student's ability to return to Carleton from a Medical Leave of Absence.

Physical Health-Medical Leave of Absence Return Questions

A form used for an off-campus physician to relay physical health information regarding a student's ability to return to Carleton from a Medical Leave of Absence.

Policies:

Informed Consent to Treatment and Privacy Practices

Information for students with ADHD

Communication Policy

Excuse Note Policy

Physicals Policy

SHAC does not store personal medications for students. We suggest purchasing a refrigerator or lock box to use in your dorm room.

Diversity Statement

At SHAC, we do not make assumptions about you or your body based on appearance, gender identity or name.  We are engaged in continuous learning to make our services more equitable and accessible. We highly value the promotion and affirmation of human diversity, and our center is committed to upholding the values articulated in Carleton College’s Statement on Diversity. We understand diversity to include, but not be limited to, race, ethnicity, language, nationality, sex, sexual/affectional orientation, gender identity, gender expression, age, size, ability, socioeconomic status, religious beliefs, and social and political worldviews. For each person who comes through our doors or interacts with our staff in other settings, we strive to establish a safe, accepting, and welcoming environment.

We recognize the impact that prejudice, discrimination, and oppression can have on emotional and physical well-being, and we pay close attention to the ways that our students, staff members, and community are affected by social injustice. Our staff and trainees claim our own personal identities and we honor those of others. We believe we must continually examine ourselves (i.e. our biases, identities, and privileges) as well as our service-delivery systems in a way that helps us better understand, connect with, and serve our community. We encourage feedback and recommendations to help us recognize problem areas, to reduce barriers, and to improve our services.