Release of Information

General Information

Disability Support Services (DSS) staff are committed to protecting the confidentiality of the students we serve. The DSS office must communicate with instructors regarding the implementation of accommodations, no Release is needed for your instructors. Otherwise, we will not disclose DSS records to any other individuals unless we have written permission to do so, or unless the law authorizes or compels us to do so. DSS follows the student privacy rights specified in The Family Education Rights and Privacy Act of 1974 (FERPA).  You have the option of signing a Release of Information (ROI) form to guide us in communicating with others regarding disability documentation and accommodations. If we do not have a signed ROI on file for you, we cannot disclose information about your accommodation plan to anyone other than you and your instructor(s), unless allowed by law/regulations.

Release of Information forms are valid two years from the date of signature. You may choose to cancel or sign an additional form at any time.  Students working with other Clark departments or outside agencies, may want to sign an ROI giving DSS permission to communicate with representatives of those agencies.

Signing a Release of Information

If you want to sign a ROI at this time, please download the Release of Information form, we have two format options. 

  1. We have a PDF Release of Information form that you can electronically sign if you have an Adobe software.

    If you are not familiar with electronic signing a PDF, this document explains How to complete the electronic signature in the PDF form. 
    Note: PDF electronic signature is not accessible for many who use Assistive Technologies. Please also read the instructions on this page.
  2. Or we have a Word document Release of Information form that you can type the content and signature or print the document and write the content, sign, scan, and send back to us by email, fax, or mail.

Instructions to ensure you complete the release correctly: 

  1. Please read the two paragraphs at the beginning of the form.
  2. Near the middle of the form, is a list of organizations and Clark departments. Please type or write your initials on the line to the left of any person or group of people in that list, with whom you give DSS permission to release information to or receive information from regarding your disability, documentation of your disability, academic adjustments, auxiliary aids, and/or academic progress. The "Other" section is a place for you to give permission for DSS staff to share information with a specific person or organization not already listed. Please note that if you add a person or organization to this "other" line, we can share all information with them unless you designate a specific type of information to be released. For example, you could list a counselor by name and limit the release to grades only.
  3. To acknowledge your understanding and agreement, please date, complete your name, include your ctcLink ID number and sign at the bottom of the form.
  4. Return your signed ROI to the DSS Office by email, via fax, or by mail. Our email address is dss@clark.edu, our fax number is 360-992-2879, and mailing address is 1933 Fort Vancouver Way, PUB 013, Vancouver, WA 98663.

If you would like DSS to be authorized on specific authorizations, use the Release of Information with Specific Authorizations form please.

If you have questions or concerns about the Release of Information form, please contact the DSS Office.  Note: The DSS office is currently in remote operations due to the COVID-19 virus. While we are in remote operations, we are available by phone and email, and our office is not open to the public.