Authorization to Release Information to SAS

AUTHORIZATION TO RELEASE INFORMATION TO STUDENT ACCESSIBILITY SERVICES (SAS) AT THE UNIVERSITY OF TEXAS RIO GRANDE VALLEY

This authorization will be in force while I am an applicant of or student at UTRGV unless revoked by written notice. I further authorize that a photocopy of this authorization be fully acceptable as an original.

This requested information will be used to help determine the student’s eligibility for services from the Student Accessibility Services Office. The confidentiality of this information will be protected under FERPA (Family Educational Rights and Privacy Act of 1974).

STUDENT ACCESSIBILITY SERVICES OFFICES

UTRGV – Edinburg Campus
Attn: Ms. Tonya Paulette
West University Drive
University Center 108
Edinburg, TX 78539
Office: (956) 665-7005
Fax: (956) 665-3840
E-mail: tonya.paulette01@utrgv.edu

UTRGV – Brownsville Campus
Attn: Ms. Tonya Paulette
One West University Blvd. 1201
Cortez Hall 129
Brownsville, TX 78520
Office: (956) 882-7374
Fax: (956) 882-7861 
E-mail: tonya.paulette01@utrgv.edu

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Student Information
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to release to UTRGV the following information: (Required)


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Accessibility Office Location
Send information to the designated UTRGV SAS office: (Required)

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