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DISABILITY INFORMATION RELEASE FORM Office of Disability Services 21000 West Ten Mile Road Phone: 248.204.4100 Fax: 248.204.4115 C405 Southfield, MI 48075 disability@ltu.eduAs required by Section

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How to fill out disability information release form

01

Obtain a copy of the disability information release form from the appropriate organization or agency.

02

Fill out the personal information section including full name, date of birth, address, and contact information.

03

Provide details about the disability including diagnosis, date of onset, and any relevant medical history.

04

Specify the purpose for releasing the information and the recipients who are authorized to receive it.

05

Sign and date the form to authorize the release of your disability information.

Who needs disability information release form?

01

Individuals who are seeking to release their disability information to specific recipients such as healthcare providers, government agencies, or legal representatives.

02

Anyone who is required to provide documentation of their disability for access to accommodations or support services.

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What is disability information release form?

The disability information release form is a document that allows individuals to authorize the release of their disability-related information to designated parties.

Who is required to file disability information release form?

Individuals who wish to disclose their disability-related information to specific parties are required to file a disability information release form.

How to fill out disability information release form?

To fill out a disability information release form, individuals need to provide their personal details, specify the information to be released, and sign the authorization.

What is the purpose of disability information release form?

The purpose of the disability information release form is to allow individuals to control who can access their disability-related information and for what purpose.

What information must be reported on disability information release form?

The disability information release form typically requires individuals to report their name, contact information, type of disability, and the parties authorized to access their information.

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