Student Athlete Authorization for Release of Information to Media
Form Template
This authorization DOES NOT apply to the release of any records pertaining to psychiatric, psychological or psychotherapeutic services.
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I understand that I may revoke this authorization by providing a written revocation of authorization to the Program Coordinator that specifically mentions release of information to MEDIA, including journalists, reporters, sports information, or any other media outlet representatives. I understand that a revocation is not effective to the extent that the University has relied on this authorization to use or disclose any information about me.
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