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Office of Academic and Student Affairs Student Access Mail code: L601 3181 S.W. Sam Jackson Park Road Portland, OR 972393098 tel 503 4945657 fax 503 4944916CONSENT/AUTHORIZATION TO DISCLOSE INFORMATION
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How to fill out consentauthorization to disclose information

01
Start by writing the date at the top of the consent authorization form.
02
Write your full name and contact information in the designated fields.
03
Mention the name and contact information of the person or organization you are authorizing to disclose information.
04
Clearly state the purpose for which the information will be disclosed.
05
Specify the type of information you are authorizing to be disclosed.
06
Include any limitations or conditions regarding the disclosure of the information.
07
Sign and date the form at the bottom to indicate your consent.
08
Keep a copy of the filled-out form for your records.

Who needs consentauthorization to disclose information?

01
Anyone who wishes to authorize the disclosure of their information to a specific person or organization needs consent authorization to disclose information. This may include individuals, patients, clients, or individuals involved in legal or financial transactions.
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Consentauthorization to disclose information is a form that allows an individual to give permission for their information to be shared with a specified person or organization.
Any individual who wishes to grant permission for their information to be disclosed to a third party is required to file consentauthorization to disclose information.
To fill out the form, the individual must provide their personal information, specify the recipient of the information, and sign the consentauthorization to disclose information.
The purpose of the form is to ensure that individuals have control over who can access their personal information and to protect their privacy.
The form typically requires the individual's name, contact information, the recipient of the information, and the specific information being disclosed.
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