Consent for Services:
I understand pre-college and educational outreach services including but not limited to: academic advising, tutoring referrals, cultural enrichment activities, career and college exploration; will be provided as needed. Services are provided by Upward Bound (UB) staff (counselors, volunteers, mentors, tutors and teachers), and are designed to help students achieve their academic and personal goals. These services are provided free of charge and at the student’s will.
ALL INFORMATION RECEIVED WILL BE KEPT CONFIDENTIAL IN COMPLIANCE WITH THE FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT (FERPA).
Release of Information:
I authorize Upward Bound to access academic and personal information in the legitimate educational interest of my student including but not limited to: public assistance, free & reduced lunch documentation, standardized test scores (state testing scores, SAT, ACT, GED), report card, unofficial transcripts, official transcripts, attendance records, information about the status of post-secondary education admission/enrollment, financial aid documentation (including FAFSA pin code, Student Aid Report, and award letters) in accordance with The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99). I understand this information is essential in assisting me/my child in preparation for post-secondary education.
I further understand all information received is for UB use only and is held strictly confidential.
I understand that I am giving the Davidson County Community College Upward Bound Program’s Director, Student Success Advisor, and office manager permission to access my student’s grade and attendance information directly from appropriate school personnel and to request other academic and behavioral information directly from school staff. I give permission for Upward Bound to access and collect this information for the duration of my student’s participation in the program and throughout his or her high school and college career; however, if I choose to withdraw this permission, I can call the Upward Bound Program Director at Davidson County Community College (336-249-8186 ext. 6420) or with the Upward Bound Student Success Advisor at my child’s school.
I understand that the rules I am held responsible to at my school campus are the same rules that apply during any event with the Upward Bound Program. If any rule is broken I understand if it becomes necessary, the UB staff will call my parents and they will be required to pick me up IMMEDIATELY. I also understand that failure to abide by any of the recognized rules may result in my dismissal from the Upward Bound Program.
I authorize DCCC TRIO Upward Bound to send communication via email, text message, school messenger, REMIND App to my email, students email, cell phone, student cell phone, or home phone. I understand that text messaging rates may apply to any text messages received. I also understand that I or DCCC TRIO Upward Bound may revoke this permission in writing at any time. I agree not to hold DCCC TRIO Upward Bound liable for any electronic messaging charges or fees generated by this service. I further agree that in the event emails, cell phone and other information changes, that I will inform DCCC TRIO Upward Bound.