Matriculation Form

Consent and Authorization to Disclose Disability Information
Updated: December 3, 2021

Due to the unique nature of the Hispanic Scholars Program (HSP), it may be necessary for HSP administrators to discuss a student’s request for accommodations, and to share pertinent documents and information, with parties with a vested educational interest in the student. These parties may include, but are not limited to, an HSP faculty member, the disability services manager of the student’s home institution, and the disability services manager of the HSP’s host institution. Per HSP Policies Regarding Disability and Reasonable Accommodation, it is the responsibility of the HSP host institution to receive, maintain, and destroy these documents in accordance with their internal policies. Determinations of reasonable accommodation will be made in coordination with the HSP, the student’s home institution, and the HSP host institution.

By clicking “I consent” below, you 1) give permission to HSP administrators to discuss your disability and accommodation request, and 2) to exchange information and documentation you have provided with parties who have a vested educational interest in your success, including, but not limited to, your HSP faculty member, the disability services manager of your home institution, and the disability services manager of the HSP’s host institution. Additionally, by clicking “I consent” below, you acknowledge the HSP Policies Regarding Disability and Reasonable Accommodations and understand the procedures set therein (see full policy at: https://tinyurl.com/hspdisabilitypolicyupdated).

This authorization will remain in effect for the duration of your enrollment in a credit-granting HSP program. It is your right to amend or withdraw any documentation you submit at any time. It is also your right to revoke consent and authorization to disclose disability information at any time.