Release of Information for FVA |
Outreach Services at Missouri School for the Blind
Release of Information Form
I understand that many agencies provide a variety of services and benefits. Each agency must have specific information in order to provide these services and benefits.
By signing this form, I am allowing the named agencies to exchange specific information to effectively provide or coordinate services and benefits.
The parties agree that this agreement may be electronically signed. The parties agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility.
If you would prefer opt-out of signing this agreement electronically & prefer to sign an agreement manually, go to the MSB Outreach Website download the ROI form, and send it to rebecca.romine@msb.dese.mo.gov