Radiation Exposure Request

The Radiation Safety Office maintains all exposure records indefinitely. A signed statement is required for us to release this report to you or your employer.

Check here if filling out on behalf of someone

Full Legal Name*

Has your last name ever changed?

MSU 9 Digit ID

Years Attended

Classification

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MSU Department Affiliation (If Applicable)

Where should we send your exposure history?*

Select or enter value

I Agree*

By submitting this form, I am formally requesting that the MSU Radiation Safety Office release my exposure history report to the designated party.

Send me a copy of my responses