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COUNSELING PSYCHOLOGY DISCLOSURE & ATTESTATION
INFORMED CONSENT





DISCLOSURE & ATTESTATION

Dear Prospective Student:  

 

 According to Federal Regulation 34 CFR 668.43(a)(5)(v), if an educational program, such as the Golden Gate University Master of Arts in Counseling Psychology, is designed to meet educational requirements for a specific professional license or certification required for employment in an occupation, or is advertised as meeting such requirements, the institution must provide information regarding whether the program would be sufficient to meet licensure requirements in a State for that occupation.  The institution must disclose to prospective students if it has determined the curriculum meets the State educational requirements for licensure or certification, if it has determined the curriculum does not meet the State educational requirements for licensure or certification, or if the institution has not made a determination the curriculum meets the State educational requirements for licensure or certification. Additionally, some states may have limitations on whether a practicum or internship is allowed and which may affect licensing. 


As of the date this form is signed, the Golden Gate University Master of Arts in Counseling Psychology meets California educational requirements for licensure and certification.  The determination for other States can be found here. Additionally, as of the date this form is signed, Golden Gate University is not authorized to provide online education to students living in the following states which can be found here.


ATTESTATION


By signing below and submitting this Attestation to Golden Gate University ("GGU"), I am attesting/agreeing to the following:
  • I am a prospective student interested in enrolling in the Master of Arts in Counseling Psychology online education program (the "Program") at GGU. GGU has made available to me a full list of states, and provided me with information about whether the Program meets or does not meet state licensure or certification requirements, or whether that determination has not been made for any given state, or whether the institution has or is allowed to provide practicums or internships that in turn may affect that Program.
  • I have had the opportunity to review the full list of states and whether the Program meets the relevant state licensure and certification requirements for the state in which I currently reside and/or intend to participate in the Program.
  • I understand that states may change their licensing and authorization requirements and that Golden Gate University cannot guarantee that program authorization and licensing will be continuous for all states and into the future.
  • If I currently reside in a state where the Program does not meet state licensure or certification requirements, I have been adequately informed of such and am aware of any associated risks with applying to the Program, enrolling in the Program and/or completing the Program.
  • If I currently reside in a state where the Program does not meet state licensure or certification requirements, I intend to relocate to a state where the Program does meet state licensure or certification requirements. I am to notify my Program immediately of relocation and the place of that relocation.  
  • I understand that while GGU has determined that the Program currently meets state professional licensure requirements in the state I wish to remain in or relocate to. I further understand that state licensure requirements are subject to change. Considering this, I understand that I should directly contact any state in which I may be interested in becoming licensed upon graduation to ensure I fully understand my employment options in that state. 
By signing below and submitting this document to GGU, I agree that I have read and understood the above, that the information I provided is true as of the time of signing, and I have been given an opportunity to ask any questions I may have prior to signing. 

Rev. 04/16/2025



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