This authorization allows the above individuals and/or organizations to copy and send records to Disability Services (DS) and allows representatives of DS to inspect the records. This authorization allows the above individuals and/or organizations to discuss my condition and needs with the DS staff.
IMPORTANT: E-SIGNATURE REQUIRED
This form requires an e-signature to be valid. Please open the below PDF in Adobe Acrobat or another app that allows you to enter information on PDFs (there are many free versions online) to e-sign the document then return it to your provider at DS.
Download the form: