This required form serves as an authorization to release information for requests for student records from the Registrar.
Please complete all fields and submit to the Registrar, Terra Collins by fax at 217-545-5538, email at firstname.lastname@example.org or by mail at:
Terra Collins, Registrar
SIU-SOM, Office of Student Affairs
P.O. Box 19624
Springfield, IL 62794-9624