STUDENT'S DECLARATION & SIGNATURE
Authorization: I declare under penalty of perjury that all information reported on this application is true and accurate to the best of my knowledge. Pursuant to 20 USA 1231a of the U.S. Department of Education, CCEOC has the responsibility to request from applicant information and supporting documents to determine eligibility and deems necessary to assist me in achieving my educational goals or in meeting the reported requirements of the U. S. Department of Education. To record pertinent facts regarding my eligibility in the program, services rendered, and post-secondary education enrollment. I hereby authorize any educational institution to release academic and/or financial aid information that is requested by CCEOC. This information is protected by the Privacy Act, kept confidential and not be seen unless specifically authorized. I also grant permission for my image to be used in relation to any CCEOC activities which could be a photograph and/or video, and may be used on the CCEOC website with only first names to be included or posted.