The present study involved detailed chart review for a sample of college students referred to a psychiatrist for pharmacologic evaluation to obtain information about clinical decisions to prescribe antipsychotic medication. Six colleges and universities referred 540 students to an off-campus consulting psychiatrist, and 40 of these students (7.4%) had been prescribed antipsychotic medication at some point in their treatment. Results indicated that approximately 33% of students who had been prescribed an atypical antipsychotic had a diagnosis consistent with FDA-approved use. In addition, roughly 33% of students who had been prescribed an atypical antipsychotic had diagnoses (e.g., eating or anxiety disorders) for which there is weak or little empirical evidence that these agents are effective. Another 33% of the sample presented with an uncertain or unusual combination of symptoms that were difficult to diagnose. Even though this study found that off-label use of atypical antipsychotics was common, only one such use seemed to deviate from accepted standards of care. The present findings are consistent with other research in showing that atypical antipsychotics often are used despite a lack sound evidence of their effectiveness. These findings are consistent with other research that atypical antipsychotics are overprescribed for young people despite limited evidence for their effectiveness, and demonstrate that this pattern may continue with college students.