Authorization for Request or Release of Medical - CSU, Chico 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your last name and first name in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Indicate whether you are 18 or over by selecting 'Yes' or 'No'. This helps determine consent capabilities.
4. Fill in your birth month and day, student ID, cell number, and email address. This information is essential for contact purposes.
5. Provide details about your faculty/coordinator and the date of the event. If applicable, include your course number.
6. Complete the emergency contact section by listing two contacts with their names, relationships, addresses, phone numbers, and languages spoken.
7. Answer the allergy questions clearly. If you have allergies, provide explanations in the space provided.
8. If you have dietary restrictions, please specify them in the designated area.
9. Finally, sign and date the form at the bottom to authorize the release of your medical information if necessary.

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