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Confidential Release of Information Form

University College Student Accessibility Services (SAS) and Delaware State University are extremely sensitive to the issue of confidentiality and are guided by the Americans with Disabilities Act (ADA), the Amendments Act (ADAAA), and the Family Education Rights and Privacy Act (FERPA) in protecting privacy rights.  All student disability files are housed securely in SAS.

While SAS does communicate with Faculty and Administration in regards to a student’s request for accommodations and accommodation facilitation, it does not share confidential information without the expressed written consent of the student or, in the instance of a verifiable need to know.  Similarly, SAS does not provide registration status, accommodation information, or any other confidential information to a student’s parent, guardian, spouse/partner, or other third party without the express written consent of the student.

A student with a disability may sign a Confidential Release of Information Form to allow the release of medical or psychoeducational documentation or to give permission to SAS to discuss disability-related information with third parties such as parents, spouses/partners, or medical/mental health practitioners. 

 

 

Filling out the Confidential Release of Information Form:

If you are a DSU Student registered with SAS who would like to fill out the Confidential Release of Information Form allowing SAS to release your personal information to individuals of your choosing, please follow these steps:

  1. Download the Confidential Release of Information Form and save it to your computer.
  2. Fill out and sign the form. The student may print the form and fill out by hand or fill out the form on their computer and sign using an approved Adobe electronic signature.
  3. Return the signed form to SAS: Forms can be returned in person to the SAS Office in Room 204 of the Library, emailed to aksmith [at] desu [dot] edu, or faxed to 302-857-7202

Removing or Changing Previously Submitted Confidential Release of Information Forms:

If you are a DSU Student registered with SAS who has already filled out the Confidential Release of Information Form and would like to remove the ability for previously designated individuals to have access to your personal information please follow these steps:

  1. Request a copy of your previously submitted form by contacting Ann Knettler-Smith, Coordinator of Student Accessibility Services, at 302-857-6898 or aksmith [at] desu [dot] edu . The form will be emailed to your DSU account or can be picked up in the SAS Office.
  2. Initial and Date the bottom section of the form indicating that you are no longer giving permission for your information to be released
  3. Return the newly initialed form to SAS: Updated forms can be returned in person to the SAS Office in Room 204 of the Library, emailed to aksmith [at] desu [dot] edu, or faxed to 302-857-7202.