Certification of Application and Information Release
I/We certify that the information provided on the application is true and correct to the best of my/our knowledge;
I/We further understand that the completion of this application does not guarantee acceptance into the Delta Educational Opportunity Center (DEOC) program.
I/We authorize the use of my image and name in DEOC publications, editorials, advertisements, and media releases to the DEOC program and its
affiliated organizations;
I/We understand that if I need accommodation for a disability to participate in DEOC, or any of its scheduled activities, I/we must contact the Director of the Delta Educational Opportunity Center at 662.846.4337 at least 10 working days prior to the activity.
I/We will make every effort to provide DEOC with any requested documentation needed to evaluate/track/report academic progress. Student information is confidential and protected by the Family Educational Rights & Privacy Act (FERPA). We cannot release or obtain certain information without your written permission.
I/We authorize DEOC to request, receive, and release any academic and financial secondary and/or postsecondary information to assist with services needed.
I/We further authorize DEOC to communicate verbally or otherwise with campus staff and faculty and/or off-campus professionals on my behalf to assist
with services needed.
My/Our consent will remain in effect until I/we revoke this authorization, in writing, with the DEOC office.