University Of Arkansas-Little Rock-EOC

Section V: How did you hear about us?
How did you hear about us?

Friend/RelativeMail/FlyerAgencyAdult EdWorkshop/Presentation
Name of referring agency, Adult Ed Program, office or workshop location

Section VII: Record Release Form
The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law that protects the privacy of student education records. The law applies to all schools that receive funds under an applicable program of the U.S. Department of Education.

The purpose of this form is to provide consent as required by FERPA to
Educational Opportunity Center (EOC) TRIO Program.

I, the undersigned, hereby authorize the release of the specified educational records and information to the UALR TRIO Educational Opportunity Center for the purpose of meeting the requirements of the U.S. Department of Education TRIO Programs and achieving my educational goals.
Please check all that apply for the person in Section I of the application:*

Verification of college/postsecondary enrollment and completionVerification of high school/GED completion, Academic transcript/grade report, Financial aid transcript, ACT/ACCUPLACER scores

Section VIII: Record Release Form Authorization
I declare that the information on this form is true to the best of my knowledge. The UALR Educational Opportunity Center Program is authorized to access information deemed necessary to assist me in achieving my educational goals or in meeting the reporting requirements of the U.S. Department of Education, to record pertinent facts regarding my eligibility in the Program, services rendered, and placement. A copy of this statement shall serve as such authorization.
Client Name
Client Signature*

Clear
Date Signed*

MonthDayYear
mm-dd-yyyy
Parent signature (If client is under age 18)

Clear
Date Signed

MonthDayYear
mm-dd-yyyy

Section IX: Media Authorization
With my initials, I authorize the TRIO Educational Opportunity Center Program at the University of Arkansas at Little Rock to use photographs and/or videotape with my image in Educational Opportunity Center publications, promotional media, social media, websites and/or news releases.
Initial here

TRIO: A Federal Funded Program
The UALR EOC program is a federally funded TRIO program and all services are provided to program participants free of charge. All individuals who meet the eligibility requirements of this program are provided information regarding financial and academic assistance necessary for them to enter college for the first time or to return if they have dropped out.

Office: 501.907.2470 • Website: ualr.edu/trioeocets • Facebook.com/eoctrio/ • Twitter.com/eoctutor Mail application to: TRIO Educational Opportunity Center, 5820 Asher Ave. Ste. 800, Little Rock, AR. 72204

Educational Opportunity Center