Career Counseling Referral Form

Thank you for your interest in the career counseling services through Penn State World Campus. Please fill out the short self-referral form with confidentiality statement below. After completing the form, you will be directed to the next page where you will be able to make an appointment.

The fields marked with an asterisk (*) are required.


Please read the confidentiality statement and make your selection below.

Confidentiality Statement:
At Advising and Learner Success World Campus we realize that you might be concerned about what happens to any records or notes kept by a career counselor after providing you with services. Please note that all records are STRICTLY CONFIDENTIAL. Information provided by you, interview session notes, career planning assessment measures, and other information such as academic records and job-related information will be kept confidential except under the following conditions: Only if you request in writing, may any part of your record be released to appropriate individuals or agencies. The counselor reserves the right to seek supervision and consultation as well as review your record with an appropriate professional colleague that will aid in providing career counseling services to you. Since career counselors do not have privileged communication in court cases, it is possible that your records would have to be released to courts if subpoenaed. If your counselor became aware of a life-threatening situation, s/he may need to notify family or other responsible personnel. It is possible that private messages could be intercepted when communicating electronically even when precautions are used. Please keep in mind that anytime you authenticate with your PSU Access Account userid and password for your PSU email, you are creating a secure encrypted network connection to Penn State's mail server. Your career counselor will always use this. This does not apply to connections made from a third-party ISP (e.g., AOL) to a non domain (e.g., Authenticated Simple Mail Transfer Protocol (authsmtp) allows users who connect via a third-party dial-up, DSL, or cable modem connection to use Penn State's outgoing email server. The authenticated version of “”, which is “”, requires a user to enter his/her password before being permitted to send messages. The server authenticates senders of outbound mail to protect the mail server from abuse from email-related viruses and spammers. Instructions for configuring the various email clients are found at: Users of Penn State ITS email services are required to check mail using a secure-only connection via SSL, a type of software that encrypts (or scrambles) individual userids and passwords when users check email via “” or “”. Because SSL configurations are client-based (i.e. Eudora, Mac Mail, Outlook), you must change your setting on your machines that use ITS mail. If you use more than one email client (with the exception of Penn State WebMail), you must also change your settings on each of your email clients on each of your machines as well. The instructions for configuring SSL for incoming email for the most popular email clients can be found at: Instant messages from your career counselor are routed through a Jabber server that “listens” for unencrypted traffic and provides an SSL-secured connection Both you and your career counselor need to use the Jabber client for secure communications. All that is needed to use Jabber is a Penn State Access Account and a local chat client configured to support Jabber. Instructions on configuring Jabber can be found at: Check with your IM provider for any other limits on the security of information you communicate by IM. Please consult your VoIP provider for current limits on security (e.g., Skype) as you consider using this technology. Because no conversation transmitted across a radio wave is completely secure, cell phones are not a completely secure communication. We ask that you be discreet in disclosing any online career counseling interactions between you and your counselor to others (e.g., not posting email exchanges on a blog or Facebook wall) to uphold the integrity of your private efforts in counseling.