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Release of Information Authorization

This authorization form is to be completed by students who wish to release their information to DSS or to authorize DSS to share their information with a third party. To view, print, or fill out the form, you should use the latest version of Adobe Acrobat Reader, which can be downloaded for free.  

Not sure how to fill out the form to release your records to DSS? Select “Receive my protected information from the following location” and add your provider’s and agency names. View the example (PDF).