The psychological report and findings conducted by Shannon D. Mullen, Ph.D. for my candidacy to the seminary program of the Diocese of Dallas, Texas are the exclusive property of the Diocese of Dallas, Texas. I understand that I will not be provided with a copy of my psychological report, findings, recommendations, or diagnoses by the Diocese of Dallas, Texas, or by Dr. Mullen/Mosaic Psychological Services, LLC. I understand that the results of my testing and interview responses are contained in my psychological report given to the Diocese of Dallas, Texas for their exclusive use.
I have been advised of the limited confidentiality inherent in this type of evaluation and that a report will be provided to the Diocese of Dallas, Texas, which is the referring party. I acknowledge this and agree to participate. The custody of this report is exclusively the domain of the Diocese of Dallas, Texas. I understand I will not be provided a copy of this report.
My printed name and signature will indicate my acceptance of the above limits to confidentiality and release of ownership as well as my agreement to participate in the psychological evaluation with Dr. Mullen.