Get Revocation Of Release Student Information - Mercy College Of ... - Mchs

This guide provides clear instructions for users on how to fill out the Revocation of Release Student Information form for Mercy College of Health Sciences. Following these steps will ensure proper completion and submission of the form.

Follow the steps to complete the Revocation of Release Student Information form.

1. Click the ‘Get Form’ button to access the Revocation of Release Student Information form and open it in the editor.
2. Begin by filling out your name in the designated field at the top of the form. Ensure that you provide your full legal name as it appears in your educational records.
3. Next, enter your Social Security Number in the appropriate field. This information is needed to identify your records accurately.
4. In the section below, specify the individual or organization to which you revoke permission to disclose your information. If the revocation is limited to a specific instructor or department, clearly state that information.
5. List the names of individuals you do not want your information disclosed to. For each person, provide their relationship to you, date of birth, and email address or phone number as required.
6. After completing the information about individuals, you will need to read the certification statement. This statement confirms that you understand your request will remain in effect until you grant permission in writing.
7. Do not sign the form until you are in the presence of an appropriate MCHS staff member or a Notary Public, as this part is crucial for validation.
8. Once signed, the form may need to be witnessed by an MCHS staff member. Please ensure this step is completed for the form to be valid.
9. If you are unable to complete the form in the presence of a staff member, you must have it notarized. This requires you to provide the Notary Public information and their seal.
10. Upon completion, review the form for any errors, then save your changes. You can download, print, or share the form as needed before submitting it.

Complete the Revocation of Release Student Information form online today to ensure your educational privacy rights are respected.