Military Family Life Counselor Consent printable pdf download

(Office use) Primary Family ID: _____________

Military Family Life Counselor Consent

If your student is the child of a military service member, retiree or DoD civilian, you may consent for them to

receive Military Family Life Counselor services. The Department of Defense has assigned a MFLC (pronounced “M-

FLAC”) to IHC Schools. MFLCs are fully licensed counseling professionals available to provide confidential, non-

medical counseling support to families dealing with the unique challenges of military life. The program is fully

confidential; no written records are made of any MFLC services.

The MFLC may support IHC staff and work with children and families in the following ways:



Observe, participate and engage in student

Outreach to parents at school and family events



activities

Available for parents for guidance and support



Provide direct interaction with children

Facilitate psycho-educational groups



Model behavioral techniques and provide

Conduct training for staff and parents



feedback

Recommend referrals to military social services



Suggest age-appropriate behavioral interventions

and other resources as needed

to enhance coping and behavioral skills

The MFLC may assist parents, teachers, staff, and children in the following ways:



Communication

Self esteem/self confidence



Resolving conflicts

Behavioral management techniques



Helping children deal with angry feelings

Sibling/parental relationships



Bullying

Deployment and reintegration issues

The MFLC may also work with children in settings such as field trips and other school-sponsored activities. The

MFLC is available to accommodate appointments and meetings/activities after hours and on weekends with

advance notice. At no time will the counselor meet individually with a child without being in line of sight of an IHC

School employee with supervisory authority, or a parent/guardian. The MFLC only uses Office of the Secretary of

Defense (OSD) approved materials for trainings, groups, and any other activities.

Consent to Receive MFLC Services

Parental permission is required for participation in any DoDEA-sponsored program. If your student is the child of a

military service member, retiree or DoD civilian, please complete below. This form will be confidentially

maintained by the school front office. Please complete one form for each child.

Name of school: Immaculate Heart Central Schools, Watertown, NY

I acknowledge that a MFLC is available and

DO NOT authorize my child to receive MFLC support.

_____________________________________________________________________________________________

Child’s Name

Grade

_____________________________________________________________________________________________

Parent/Guardian Name

Date

Military Family Life Counselor Consent

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