instructions

Instructions
The purpose of this document is to reduce the barriers for students with disabilities to release their student records. Students 
may fill this form out at any participating “verifying institution” in order to release disability service records from any 
participating “sending institution” to any other participating “receiving institution.” All three institutions must be listed below 
as participating in the use of the common form.

Process:

1. Fill out the document infull:
   • Student ID field is ID used at the sending institution
   • Student address and phone number field must be filled out to ensure there is current contact information for verification 
     purposes of sending institution
   • Student will have to provide the contact information of the institution sending the student records and the contact 
     information of the institution receiving the records.
   • A verifying institution may be the sending institution or a third-party institution, providing a service to the student as a 
     courtesy to the sending institution and receiving institution. Verifying institution must verify the identity of the student
     and the verifying institution’s contact information for purposes of verifying the document
2. Student must sign or acknowledge the document in the presence of disability services staff at the verifying institution,
   including satisfactorily providing proof of identity.
3. The form is sent from the verifying institution to the sending institution, and a copy may also be sent to the receiving 
   institution. Verifying institution may mail hard copy original to the sending institution or destroy in accordance with record 
   management policies