Release of Information to Parent(s) or Guardian(s)
I give my permission to the Office of Disability Services (ODS) to discuss with my parent(s) or
guardian(s) (named below) my interactions with an ODS representative.
Name of parent(s) or guardian(s):
____________________________________________________
____________________________________________________
____________________________________________________
This consent may be revoked at any time upon written request.
_________________________________________________________________________
Student Signature / Date
_________________________________________________________________________
Printed Name / MUID
_________________________________________________________________________
Office of Disability Services Representative / Date
Office of Disability Services Marquette University P.O. Box 1881 Milwaukee,WI 53201
Phone: 414-288-1645 Fax: 414-288-5799
ODS 07/2013