UB Central Information Disclosure - Student
Date of Birth:
I voluntarily authorize and request disclosure (including paper, oral, and electronic interchange) of all education records and other information directly or indirectly related to my/my child's education and career development. This includes specific permission to release:
TO WHOM: Forward Service Corporation employees assigned to the Upward Bound program.
PURPOSE: To determine Upward Bound program eligibility, to develop and implement an Upward Bound program plan, and to evaluate progress in the program for the student named above.
Student's Email Address:
Leave this empty:
Your legal name
Your email address
If you have questions about the contents of this document, you can email the document owner.
Document Name: UB Central Information Disclosure - Student
Agree & Sign
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