UMass Boston

Release Form

I agree to the mutual release and exchange of information between the Ross Center for Disability Services and the person or agency specified below related to my diagnosis, treatment and accommodations.

I understand that information about me may be shared with other faculty and staff of UMass Boston on a need-to-know basis.

Complete the Release Form below

Name of person submitting this form

Person(s) or agency with whom information will be shared

Student Information

Additional Comments