Permission to Contact Form

MSU faculty or staff members who wish to refer a student to our program for support, please fill out The Permission to Contact with the student.

This form gives MSU Center for Survivors staff permission to make contact with the person signing the form to offer support, counseling and advocacy services.

Anyone in the MSU community who has been sexually assaulted or sexually harassed can sign the form. No one is required to sign the form. The person signing the form may designate how they wish to be contacted (phone, email, in person, etc), and they are not obligated to meet with MSU Center for Survivors staff.

MSU Center for Survivors Permission to Contact Form

 

MSU Center for Survivors Permission to Contact Form