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ICHAT Release Form

ICHAT Release Form for Field Experiences

ICHAT release form must be submitted to CSS EHS 421 on or before the listed due date.

Failure to submit the release form by the due date listed may result in removal or delay from the required field experience.

ICHAT Release Form *

Results will be valid only for the semester and placement experience for which it was submitted. A student that requires multiple field experiences must present an updated consent form for each experience as needed every semester. 

As with all documents submitted the consent form and the results of the search become property of the university and under no circumstances will be returned or provided to the student.

If changes occur in the information submitted on the Form, you are required to inform the Center for Student Services (989-774-3309) located in EHS 421 within 48 hours (2 business days) of the offense.

Please print the form, sign and return to EHS 421 on or before the due date listed above.

You may fax (989-774-3624) scan and e-mail (stran2sc@cmich.edu) or mail the completed form to:

Central Michigan University
Center for Student Services, EHS 421
Attn: Sarah Venman
Mt. Pleasant, MI 48859

* This .pdf is an interactive form that may require you to download the newest version of your browser. If you cannot see the drop-down menu options on the .pdf, try saving the file to your computer or using a different browser.

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College of Education and Human Services | Central Michigan University | ehs@cmich.edu | 195 Ojibway Ct | EHS 426 | Mt. Pleasant, MI 48859 | (989) 774-3079

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