This disclosure document serves as consent for exchange of information regarding a student with whom I am working. This authorization shall remain in effect until the termination of services by either Jodi Walder-Biesanz or the person who has signed below. A photocopy or facsimile of this authorization shall be as valid as the original. I welcome an exchange of information regarding any college planning and academic issues and in general an open, collegial relationship that would benefit the student. If you have any questions, please feel free to contact me via phone, e-mail or fax. I look forward to working with you.