Electronic Consent to Release

EDUCATIONAL ASSISTANCE CENTER

ELECTRONIC CONSENT TO RELEASE
Oxnard College - Educational Assistance Center

4000 S. Rose Ave . Oxnard CA 93033-6699

Phone (805) 678-5830 Fax (805) 678-5928
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*
example@example.com
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
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 seven years after case closure, and then destroyed.
Should be Empty:

EDUCATIONAL ASSISTANCE CENTER