Lehman College 

THE CITY UNIVERSITY OF NEW YORK 

 

Office of Student Affairs Office of Student Disability Services 

Shuster Hall, Room 206 Shuster Hall, Room 238 

250 Bedford Park Boulevard West 250 Bedford Park Boulevard West 

Bronx, New York 10468 Bronx, New York 10468 

Tel: (718) 960-8241 Tel: (718) 960-8441 

 

 

 

 

COLLEGE RELEASE OF INFORMATION 

 

 

 

I, _______________________________, (S.S.# ______ - _____ - _____) hereby 

 Print Name 

 

give permission to the Office for Student Disability Services, Merrill D. Parra, Director, to 
release information related to the nature of my disability to the following office(s), faculty 
and/or staff at Lehman College: 

 

___ Public Safety Office 

___ Student Health Center 

___ Registrar 

___ See attached printout 

___ The following instructors (specify below): 

Prof Class 

______________________________________ 

______________________________________ 

______________________________________ 

______________________________________ 

 

_____________________________ _________________ 

 Signature Date