Release of Information Form | Office of Title IX Programs and Gender Equity

Release of Information

Student Name(Required)

First

Last

Pronouns

CSU ID(Required)

Date of Birth(Required)

Phone

I give permission to Office of Title IX Programs and Gender Equity to release information by verbal or written communication with:

Name/Agency(Required)

Relationship

Phone

Fax

Mailing Address

Street Address

Address Line 2

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State / Province / Region

ZIP / Postal Code

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Please indicate the information you are authorizing Office of Title IX Programs to release (i.e. case status updates, dates/times of scheduled meetings, Preliminary Investigative Report, etc.)

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This field is for validation purposes and should be left unchanged.

Office of Title IX Programs and Gender Equity

Release of Information

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