ARCHDIOCESE OFATLANTA

DIACONAL FORMATION PROGRAM

RELEASE FORM

I, ___________________________________, understand that in order to be admitted to Candidacy in the Diaconal Formation Program (Candidacy), which could lead to reception of Holy Orders (Holy Orders) in the Roman Catholic Church, I must be interviewed by one or more clinical psychologists (the psychologist(s)) chosen by the Archdiocese of Atlanta (the Archdiocese) for the purpose of evaluating my fitness to enter Candidacy and to continue formation (the evaluation).  I hereby grant permission to the Archdiocese to schedule my interview with a psychologist, selected by the Archdiocese, for the purpose of the evaluation.

I understand that the results of this evaluation become the property of the Archdiocese and that any reports (the evaluation reports) provided by the psychologist(s) will be maintained by the Archdiocese as confidential, and will not be disclosed to third parties, other than necessary Archdiocesan employees, including, but not limited to, those involved in the decision to admit me to Candidacy (necessary Archdiocesan employees), or as may be required by law. I also understand that I am not entitled to review or obtain a copy of any such evaluation reports.  Notwithstanding the foregoing, the contents of any such reports may be reviewed with me by necessary Archdiocesan employees, at the sole discretion of the Archdiocese.

Signed this date ____________________

Signature _________________________

Witness __________________________