I hereby authorize and request that Dr. Rebecca Jones, Assistant Vice President of Campus Life, the Dean of Arts and Sciences, or the Dean of Pharmacy be able to release and/or obtain all confidential information acquired in the course of the evaluations and treatments of my disability. This information is to be solely used for the purpose of providing academic accommodations. I give Dr. Rebecca Jones, or the Deans' Offices my permission to speak with the following people on my behalf, regarding academic accommodations, without my need for additional consent: