Title: Technical Assistance Request Form
Author: Susanne Morgan Morrow
Last saved by: Gen Hendrey

Queens College 
Powdermaker – Rm. 200 
65‐30 Kissena Blvd. 
Flushing, NY 11367‐1597

Release of Information and Education Records

I hereby authorize (name of your child’s school): ______________________________________ to release
(your child’s name): _________________________________ educational records, including evaluations, updates,
IEP’s, and other pertinent educational information to The New York Deaf‐Blind Collaborative in their role as technical assistance providers.  Furthermore I authorize the staff of the school to discuss my child’s educational program with staff from the Collaborative on an ongoing basis.

Name of Parent(s) or Guardian:
Signature:
Address:
Phone:

If you have any questions about this release please contact: 
Sam Morgan 
Project Director 
718‐997‐4853 
samuel.morgan@qc.cuny.edu