Veteran and Military Student Success
UNIVERSITY OF SOUTH CAROLINA AIKEN
RELEASE OF INFORMATION
TO FACULTY/STAFF/SERVICE PROVIDER
I hereby authorize the staff of the Veteran and Military Student Success Center at the
University of South Carolina Aiken to release any pertinent medical, psychological,
educational, or vocational information to the faculty and staff at the University of South
Carolina Aiken and/or other providers of supporting services; to include, the Aiken Warrior
Project. This disclosure is to assist me in fully participating in an educational activity. Disclosure
of information will be restricted to what is necessary, relevant, and verifiable.
Nature of Information:
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Era of Service
VA Disability Information
Education Benefit Information
Military Service Information
VA Benefit Information
I understand that I have a right to revoke or change this authorization at any time by giving
written notification to the Veteran and Military Student Success Center, University of South
Carolina Aiken, 471 University Parkway, Box 37, Gregg-Graniteville Library, 471 University
Parkway, Aiken, SC 29841.
Student’s Name (Print) ______________________________________________
Signature __________________________________ Date __________________
Witness signature ____________________________ Date __________________