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. 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.

Students may sign ROIs for various reasons throughout the year. The inclusion of this agreement as part of the Policies & Procedures process is intended to ensure that you are aware of your option to sign a Release of Information. Release of Information forms are valid two years from the date of signature. You may choose to cancel the form at any time. You may also choose to sign an additional form at any time.

Students working with outside agencies, such as the Division of Vocational Rehabilitation (DVR) or the Department of Services for the Blind (DSB), may want to sign an ROI giving DSS permission to communicate with representatives of those agencies.

Please note that for the form to be considered valid, you must initial next to each individual/group you choose to authorize. If you mark items with a checkmark or an "X," the form will not be considered valid.

If you have questions or concerns about the Release of Information form, please contact the DSS Office at (360) 992.2314 or (360) 991.0901 VP.

Signing a Release of Information

If you want to sign a ROI at this time, please download the Release of Information form. Then, follow the numbered instructions carefully to ensure that you fill it out correctly. You can also pick up a blank ROI at the DSS Office.

Please remember, this form must be signed in ink.

  1. Please read the two paragraphs at the top of the form.
  2. In the middle of the form, there are two columns.  Please locate that section.
  3. Now write in your initials next to 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 allinformation 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.
  4. The “Specific Authorizations” section of this form only pertains if you are authorizing DSS to request records from an external party (e.g. previous high school, mental health therapist, doctor’s office, etc.) By placing your initials next to the two sections labeled “Drug and Alcohol” and “AIDS/HIV”, you are permitting external parties to release this type of information to DSS.  You may ignore this section if you are not allowing DSS to request records, and/or you do not wish to grant permission for this type of information to be released to DSS. 
  5. Read the agreement beginning with “I understand that I may cancel this authorization at any time…”
  6. To acknowledge your understanding and agreement, please sign, date, print your name, and include your student ID number at the bottom of the form.
  7. Return your signed ROI to the DSS Office in person, via fax, or by mail. Our mailing address is 1933 Fort Vancouver Way, PUB 013, Vancouver, WA 98663. The DSS office fax number is 360-992-2879.