Release of student information consists of the following:
- Student name
- Student ID number
- Date of birth
I hereby authorize Lower Columbia College, DAS Director, Mary Kate Morgan, to provide
information contained in the educational records of the above named person to the
following named individuals or organizations:
All agencies and/or persons with legitimate educational need to know:
Or check specific groups below with whom we may share information.
- All faculty
- Specific faculty only (please list)
- Parents or guardians (names)
- Previous/future educational institutions
- Medical/counseling facilities
- Recordings for the Blind/Library for the Blind
- Department of Vocational Rehabilitation
- Department of Labor & Industries (L&I)
- Other (please identify)
This release is in effect for the period of:
I understand that I must have documentation on file at the DAS Office to be eligible
for services as a student with a disability. I have a responsibility to identify myself
as a person with a disability on the registration form, and in the case of Federal
auditors, my records may be opened.
- Signature of student
- Phone number/email
- Date