Consent for Release Form - California Institute of Technology - counseling caltech 2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your name in the designated field for 'Name of Client'. This ensures that the form is personalized and accurately reflects your identity.
  3. Next, input today’s date in the 'Today’s Date' section. This is crucial for tracking the validity of your consent.
  4. In the authorization section, initial next to both options if you agree to discuss information verbally and receive relevant information from specified individuals.
  5. List the names and phone numbers of individuals authorized to exchange information. Ensure all contact details are accurate for effective communication.
  6. Select the purpose of this release by checking appropriate boxes such as Academic Accommodation or Coordination of Treatment. If there are other purposes, specify them clearly.
  7. Indicate any limitations on this authorization, if applicable, to clarify what information can be shared.
  8. Finally, sign and date the form at the bottom. If someone is signing on your behalf, ensure they provide their details as well.

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