CAPSS > Office for Students with Disabilities >
I, , give permission to the Office for Students with Disabilities to obtain information from and/or release information to:
Academic Advising
Admissions Office
Audiology Department
Career Center Staff
Gallaudet University Faculty/Staff
Learning Disability Diagnostician
Medical Personnel
Student Health Services
Tutorial Center Staff
University Couneling Center
Vocational Rehabilitation Counselor
Other - Specify Title:
Name:
Address:
Fax:
Phone:
Student Signature:
Student E-Mail:
(Typing your name is equal to your signature agreeing to what you have filled in).
Date:
Staff Signature:
Staff E-Mail:
(Typing your name is equal to your signature agreeing to what you have read).
Thank You.
For more information or assistance, contact:
College of Liberal Arts, Sciences, and Technologies Center for Academic Programs and Student Services (CAPSS) Gallaudet University Student Academic Center Room 1220 800 Florida Ave. NE Washington, D.C.20002-3659 (202) 651-5256 (V/TTY) oswd@gallaudet.edu