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Signature of Student Date This authorization is valid for a period of five 5 years from the date of signature and may be revoked at any time by written notice to the Dean of the College of Nursing. Submit completed forms to Spokane WSU College of Nursing Attn Susan Blair PO Box 1495 Spokane WA 99210-1495 Yakima WSU College of Nursing Attn Mary Gonzalez 1401 W Prasch Ave Yakima WA 98902 Tri-Cities/Walla Walla WSU Tri-Cities Attn Rhonda Bushmaker 2710 Crimson Way Richland WA 99354 Vancouver...
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It is a form used to authorize the release of student information to specified individuals or organizations.
Students or their legal guardians are required to file this form.
The form should be completed with the student's personal information and signed to authorize the release of information.
The purpose of this form is to protect the privacy of student information and regulate its release.
Personal information of the student and details of the authorized individuals or organizations should be reported on this form.
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