Student Information Request Form

With few exceptions, state law gives you the right to request, receive, review and correct information about yourself collected on this form (See below).

The form below is to be completed by a student requesting information on JAMP.

All others should email their requests to
*Required Data cannot be left blank.
This information is used for state and federal reporting purposes.
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Financial Aid:    
Right to Review and Correct Information
Under state law:
  • You are entitled to request to be informed about the information that the Joint Admission Medical Program (JAMP) collects about you, with some exceptions;
  • You are entitled to receive and review the information in accordance with the Public Information Act;
  • You are entitled to have JAMP correct any information about you that is incorrect.