Disclosure Statement

You can read here or download the statement below (PDF File at bottom of page)

Michael A. Garcia
AMS School Counselor

BS. Chadron State College

BA. Chadron State College

              I, Michael A. Garcia, am a provisionally-endorsed in School Counseling in the State of Nebraska and I am currently in the Practicum stage of the Chadron State College Master’s in School Counseling degree program.  I am scheduled to receive my degree and full endorsement in the summer of 2015.

As a school counselor, I offer a support service program to help empower all students to function at full potential in the school setting by assisting them in their academic, psychosocial, and career development endeavors.

The nature of my role as school counselor does not permit me to perform long-term counseling services; however, I can provide crisis and short-term therapy. I am a person-centered counselor, but I also utilize problem-focused, goal-directed strategies to help students resolve the challenges they are facing. If students require more intensive help, I will suggest they seek assistance outside the school with a therapist or counseling agency that can provide a more appropriate level of individual and/or group counseling. It is important to note that when a student seeks counseling services outside the school setting, neither I, nor Alliance Public Schools, accepts the responsibility for payment of counseling and/or therapy services.

As a provisionally-endorsed School Counselor in training, Nebraska law requires that counselors provide students and their families with certain information.


Students’ Rights

Students are entitled to know my qualifications as a School Counselor. If you have any questions about my abilities and qualifications, please feel free to ask.

As Your Counselor:

·       I will inform you of the reasons, goals, techniques, and rules of the counseling process by which you may receive counseling services.

·       I will treat all students with respect as unique individuals. I am genuinely invested in your academic, psychosocial, and career development needs and will encourage your investment, as well.  To aid in your development, when it is deemed beneficial, I will share information about you with other staff members within our school.  Information will only be shared with staff members if it is necessary to evaluate, counsel, and assist you with your psychosocial, academic, and career development needs.

·       I will protect the confidentiality of information received in our counseling relationship in compliance with federal and state laws, written policies, and ethical standards. I will also protect the confidentiality of your school records and only release personal data in accordance with laws and school policies.

·       Legally and ethically, I may break confidentiality and involve other individuals who can help in the event of any of the following scenarios:

o   If mandated by a court of law.

o   If disclosure is required to prevent clear and immanent danger to you or others.

o   If I am made aware of a potential or actual occurrence(s) of physical/sexual abuse of minors, persons with disabilities, or senior citizens.

o   If you have a disease that is both communicable and fatal, I will disclose information to any identified third party who is at high risk of contracting the disease, providing that you have not already informed him/her or are not intending to do so.

o   If you are participating in group counseling sessions, I cannot guarantee confidentiality of information that is provided therein, because of the nature of group counseling.  Although, all group members are cautioned to refrain from sharing personal information obtained about fellow group members as a part of the group counseling process to anyone outside the group, I cannot ensure that they will always maintain confidentiality.

·       As your school counselor I will respect the inherent rights and responsibilities of your parents and may share information with them about you, if it is deemed beneficial.  I am mindful of cultural and social diversity among families and I will adhere to the laws and local guidelines as they pertain to assisting in your development and welfare. I recognize that all parents (custodial and non-custodial) are granted certain rights and responsibilities for the welfare of their children by virtue of their position and according to the law.

·       Because dual relationships exist in small town school settings, I will clearly state, define, and maintain ethical, professional, and social relationship boundaries with students before engaging in activities that might blur those boundaries.  Counseling services may be terminated, if the professional relationship cannot be kept separate from the personal relationship.

·       I will abide by all federal and state laws pertaining to the ethical treatment of minors. I will observe the Code of Ethics of the American Counseling Association and the American School Counselor Association. Additionally, I am governed by the policies, procedures, and standard practices established by the State of Nebraska Health and Human Services.


If you have questions, concerns, or complaints, please contact Michael Garcia, directly, or follow the chain of command addressed in Alliance Public Schools policy and Parent Handbook.


If you understand the above information regarding student rights and confidentiality, please sign below and return for record-keeping purposes. You have the right to maintain a copy of this statement.




Student’s Signature Date




Parent’s/Guardian’s Signature Date




Counselor’s Signature Date


APS Tech,
Sep 22, 2015, 2:07 PM