Unlv DRC-ReleaseInformationForm-2019Authorization for Disclosure of Personal Information 2026

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  1. Click ‘Get Form’ to open the unlv DRC-ReleaseInformationForm in the 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 agency from which information will be released, as well as the recipient details (UNLV Disability Resource Center).
  4. Specify the purpose for releasing your information in the provided space.
  5. Review the list of information types to be released. Initial next to each line that you authorize, including Medical/Psychological Assessment and Educational Records.
  6. Indicate your consent for information to be faxed or emailed by selecting 'Yes' or 'No' for each option.
  7. Sign and date the form in front of a Disability Resource Center Official. Ensure a witness also signs and dates where indicated.

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