|
|
|
Carroll Rhodes Director Russell Hall 105 570-484-3054
Fran Yeager Secretary Russell Hall 132 570-484-2409
|
Upward Bound Release of Information
I, __________________________________, hereby give my permission to release Student's Name information to the Upward Bound Project as indicated below: Grades/Standardized test scores Family income information Final transcript Other Financial aid information This release of information form authorizes the school and future university or college to provide Upward Bound with educational and/or financial records. The school principal or guidance counselor and the college’s personnel are authorized to send the requested materials. I understand that this information will be used by the Upward Bound Project to design or modify an individual educational action plan for the student and to monitor the student’s academic progress.
_____________________________________________ Date ____________ Student's Signature
_____________________________________________ Date____________ Parent's/Guardian's Signature
|
