Release of Information Form

The Disability Resource Center strives to protect the confidentiality of students with disabilities. Students with disabilities must be aware, however, that if an instructor or other staff member is asked to provide an accommodation, he/she/they may contact the DRC for verification of a disability and clarification of the appropriate accommodations for that student. While DRC staff will not release the documentation or the specific diagnosis without the student’s permission, they will verify that the student has appropriate disability documentation on file with DRC and share with the instructor/staff member the appropriate accommodations needed to provide access to University programs and services.

“I understand that if a University of Louisville faculty or staff member is asked to provide a disability-related accommodation, that person may contact the Disability Resource Center for verification of my disability and clarification of appropriate accommodations. I understand that all information released and discussed will be utilized only for the benefit of my educational program at the University of Louisville. Further I understand that I may amend this agreement at any time and, unless I note otherwise, it will remain in effect until completion of my program at University of Louisville.”

Release Decision  


Please type your first and last name below to indicate your understanding of this information.

A Department of STUDENT AFFAIRS

Disability Resource Center

119 Stevenson Hall

University of Louisville

Louisville, Kentucky 40292

Office Hours

M-F 9:00am to 5:00 pm

Phone

tel (502) 852-6938

fax (502) 852-0924

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