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I give permission for the Office of Student Integrity and Conduct to release information in my judicial file to the individual(s) listed below. I realize that this form remains in effect until I provide written notification to revoke the consent privilege of the offices/ departments listed. Note: The letter to revoke consent privileges must be submitted to the Registrar’s Office in Ellison Hall.

 
 

Information to be released to:

By signing this form electronically, you give permission for disclosure by the offices indicated below