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Release of Information Form

The release of information form is allows your UAC coordinator and listed individuals (i.e. Parent, physician, mental health professional, etc.) to exchange information concerning your treatment (i.e. evaluation/assessment data, diagnostic information, educational accommodative services, and/or information pertaining to psychological or medical treatment). 

Click to download the Release of Information Form

Please sign and FAX this to the UAC at 801-422-0174, or email at, or bring it into 2170 WSC.