Counselling & Welfare Consent — MUT-CF-004 | Data Privacy Management System

MUT-CF-004

Counselling & Welfare Services —
Confidential Consent Form

Confidentiality & Special Category Data — KDPA s.44

💙 Confidentiality: Information shared in counselling is strictly confidential. Your counsellor will not share your information outside the Counselling Unit without your consent, except where there is serious risk to life or where required by law.

Mental health data is a special category of personal data under KDPA s.44. MUT processes this data only with your explicit consent.

Access	Named counsellor and Head of Counselling only
Retention	7 years after departure from MUT
Lawful Basis	Consent (s.30(a)) and Vital Interests (s.30(d)) in emergencies

Your Explicit Consents — KDPA s.32 & s.44

🚫 Withdrawal: You may withdraw consent at any time without affecting access to counselling. Contact: dpo@mut.ac.ke

Emergency Contact

Emergency Contact Name

Relationship

Emergency Contact Phone

Your Details

Full Name *

Student ID *

School / Faculty

Year of Study

Declaration: I voluntarily consent to receiving counselling services from the MUT Counselling Unit and to the processing of my personal and mental health data as described. I understand the limits of confidentiality and my right to withdraw consent at any time.

📋 RESTRICTED — Special Category Data. Accessible to named counsellor and Head of Counselling only. Reference: MUT-CF-004.