Please sign by typing your name. *
By typing my name below, I hereby authorize personnel of the Colorado/Montana/ Wyoming State area Conference of the NAACP (President, Legal Redress Committee) to inspect and review any and all records, files, test results, interview notes, memoranda, and any and all other documents pertaining in any fashion to me, including but not limited to school records, medical records, psychological and psychiatric records, and any other records in the possession of any person or agency, public or private. Please supply copies of the original information only, when applicable.