Electronic Consent to Release

Your verification records may only be sent to your VCCCD email. Please contact our office with any questions.

Student Name

Student ID #

With my signature below, I am giving consent for the Educational Assistance Center to email my disability records to me at my VCCCD email address:

VCCCD Email Address

You must use your school email.

Oxnard College EAC may send your records to other
VCCCD DSPS departments ONLY
(Moorpark College ACCESS/Ventura College EAC)

Student records WILL NOT be sent to any other college,
university or organization.

I would like a copy of my records sent to Moorpark College ACCESS or Ventura College EAC.

I would like my records sent to another VCCCD campus (Moorpark College or Ventura College).

Further, the Educational Assistance Center (EAC) will email the records being requested but cannot guarantee the identity of the person receiving the email.

By signing my name below I am requesting the documents be sent and understand the liability.

Student/Guardian Signature

Today's Date

Please know that all materials relating to you are secured within the EAC. Case notes and reports are the property of this department, but your materials used to establish your eligibility are available for you to have copies made if you so desire. All materials and records are kept a minimum of five years after case closure, and then destroyed.

ELECTRONIC CONSENT TO RELEASE