Please use the form below to request information from The William George Agency. This form should be used for requests pertaining to residents (e.g., medical clinic, residential treatment, vocational or other records from time in program) as well as for requests pertaining to staff (e.g., employment verification). Please fill out “special information” with as much detail as you can about your request and any specific instructions. Do not include any confidential or sensitive information through this form (e.g., social security number). Once your request has been received, you will be contacted by a staff member who can best complete your request. Kindly allow 48 hours for routine requests. For other requests than those listed above, please contact the main switchboard at 607-844-6460.
NOTE: Please do not use this form if you want to obtain a transcript, graduation verification, immunization or other school-related records (e.g., IEP or other testing). For such requests, please complete the form on the GJR UFSD website.
For requests of Medical Clinic records, you must complete an Authorization for Release of Health Information form. Click here to download and get started on the form.
Fields marked with an * are required