Release of Information

I certify that the information I have on this application is, to the best of my knowledge, complete and accurate. Furthermore, I understand that by applying for the SSS program, I authorize SSS program staff to obtain records or data pertinent to my participation from other sources including financial aid and academic and academic records, and to release information to the United States Department of Education, TRIO programs. The SSS program staff also has my permission to communicate with staff, faculty, and/or off-campus professionals on my behalf.

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Signature of Applicant                                                                       Date

Student Publicity Release

I agree that if I am accepted into the Student Support Services program, the staff may include my name and/or picture in publications, including their website. The website highlights student accomplishments and participation in campus and Student Support Services activities.

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Signature of Applicant                                                                       Date

Disability Release of Information

I, _________________________ hereby give permission to the Office of Disability Support Services to release information about my disability to the Student Support Services program. This information will only be used to meet the requirements for the US Department of Education in qualify for the program, maintaining records, and providing the best possible services based in the specific needs of my disability(ies).

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Signature of Applicant                                                                       Date