Upward Bound Central Information Disclosure Student
Student’s Name: Date of Birth:
Student’s Email Address:
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:
FROM WHOM: School I am/my child is enrolled in:
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.
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Your legal name
Your email address
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Document Name: Upward Bound Central Information Disclosure Student
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