give my permission to the Academic Advising Office staff to share necessary
information with relevant members of the faculty, administration, and staff of Clark
I understand the sole purpose of this is to help me with my program of study at
Clark University. Any information that is shared will be kept confidential and used
only for the stated purpose.
I also understand that this release of information can be changed or revoked by me
at any time. Specifically, I would like to request that the following faculty members
receive memos of accommodations for the semester indicated below.
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