PDF
…on this form. You may revoke this consent, in writing, at
any time except to the extent that action has already been taken upon this release.
Requested By (Student)
Name (last, first, middle initial)
Date of Birth
Current mailing address (street or P.O. box number, apartment number, city, state, and ZIP Code)
myWSU ID number
Phone number with area
code…
https://www.wichita.edu/services/careteam/_images/DiscloseEducationRecords.pdf