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

City

State / Province / Region

ZIP / Postal Code

Country

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.)

Name

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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