Electronic Consent to Release

ELECTRONIC CONSENT TO RELEASE
Your verification records may only be senr to your VCCCD email. Please contact our office with any questions.

(805) 678-5830 | oceac@vcccd.edu
Student Name
900#
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.
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

Clear
Today's Date

MonthDayYear
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.
Should be Empty:

ELECTRONIC CONSENT TO RELEASE