Release of Information Form

Obtain  the form in Word format, here--> Release of Information

Obtain the form in PDF format, here-->  Release of Information PDF


Guidelines for Completion of the Release of Information Form


The student must complete the form in the following manner:

Name

The top should contain the identifying information of the person to whom the information is to be released. If the student wishes to have their own information released to them, they should put their own identifying information.

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Purpose
Whatever your purpose in having the information released to you should be indicated. This is helpful in guiding staff members in releasing information to third parties. For instance, if your intention in having information released to a counselor is to have the counselor best understand the behavioral history in order to identify a course of treatment for a student, this is important information for SCAIP staff to have when discussing the file with the counselor.

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How to Release Information

  • "Verbal communication" means that the information in the file may be discussed. This must also be indicated if a student is to have an advisor with them in a meeting since information regarding the student's file will be released to a third party.
  • "Copies of documents" is indicated when the student wishes to have copies of the documents in their file. Where appropriate, third party student information will be redacted. Copies of documents are not provided until payment is received by SCAIP. The cost of copying is provided on the second page of the form. There is an extra charge for mailing copies.

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What Information to Release
If a student has more than one incident, this section is what allows the student to control whether the information released pertains to the current issue or the previous one(s).
  • Releasing all information is just that; all information in the file.
  • If a student wishes to indicate a particular issue, they must check off the second option and indicate the specific date of the issue they want released.
  • If a student only wants information regarding a specific document, for example a copy of the paper that has been referred or a copy of the incident referral form that was submitted, they should indicate the last option in this section as well as the specific document.

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Date Range for Release
This section allows the student to specify how long they wish to have the information released.  For students completing the form for the intention of having an advisor present, we recommend indicated the last "one time release" option.

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Hearing Tapes/CDs Duplication

  • SCAIP only records Committee Reviews that go before the Student Conduct Committee and College Academic Integrity Committees.  Therefore, this section only applies to students who wish to obtain tapes/CDs from theses types of hearings.
  • A student must indicate whether the tape/CD will be picked up or mailed.  There is a cost associated with duplication of tapes/CDs and an additional cost for shipping copies of tapes/CDs.

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Submitting the Release of Information Form

  • Students should bring the completed form in person to Student Conduct & Academic Integrity Programs in 133 Costo Hall. 
  • Students will be asked to present identification and should be prepared to do so.
  • If there is duplication (photocopies or tape/cd duplication) required, your request will not be processed until payment is received.  Therefore, it is recommended that you use the copy fee chart on page 2 of the form to estimate the costs and come with a blank check in order to properly submit payment.

 

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