Release of Disability Related Information
I understand that in order for the DSS office to verify my
disability, as well as the functional manifestations of my disability for which
academic adjustments, auxiliary aids and/or other accommodative services may
be required, DSS must obtain pertinent student evaluations, psychological reports,
transcripts, and medical reports. I understand that to obtain these reports
this form must be signed and on file in the DSS office.
I understand that no one other than DSS personnel has immediate access to my
DSS files, and that any information regarding my disability which is gained
from these files shall be considered confidential and will only be shared with
others within the institution on a need-to-know basis. I further understand
that my reports will not be released by DSS except in accordance with federal
and state laws.
Therefore, for the purposes noted above and in accordance with the conditions
specified, I hereby authorize release of information from my reports to authorized
personnel at Midwestern State University and its DSS office.
Midwestern State University is not obligated to honor disability accommodations from previous institutions.
Academic requirements that are essential to the program of instruction being pursued by the student or to any directly related licensing or certification requirement will not be modified, substituted or waived.