Unlv DRC-ReleaseInformationForm-2019Authorization for Disclosure of Personal Information 2025

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  1. Click ‘Get Form’ to open the unlv DRC-ReleaseInformationForm in our editor.
  2. Begin by entering your name, NSHE number, Rebel Mail, and phone number in the designated fields at the top of the form.
  3. In the section labeled 'I HEARBY AUTHORIZE INFORMATION TO BE RELEASED', fill in the name and address of the agency or person from whom information will be released, as well as their contact details.
  4. Indicate whether you allow mutual disclosure between agencies by checking the appropriate box.
  5. Specify the purpose for release in the provided space and initial each line under 'Information to be Released' that you authorize.
  6. Choose your consent preferences for faxing and emailing information by selecting 'Yes' or 'No'.
  7. Sign and date the form in front of a Disability Resource Center Official, ensuring all required signatures are completed.

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