My signature below indicates that, to the best of my knowledge, I have given you on this application true statements, complete and accurate. With my signature, I hereby grant permission to Student Support Services Inspired to Achieve to gather my ACT scores, financial aid reports, transcripts, and other necessary information in order to provide the services I have requested and to make reports to the US Department of Education for the re-funding of this program. I also authorize SSS Inspired to Achieve to obtain periodic reports from my instructors regarding my academic progress for courses in which I am enrolled. I understand that all information will be kept confidential and will be used for the following purposes: 1) student demographic data and record keeping, 2) program evaluation, 3) needs assessment, 4) federal reporting, 5) other administrative purposes. I grant permission to use photographs, quotes, accomplishments, statements, and/or print my first and last name in any publications for Student Support Services Inspired to Achieve.
I have read and agree with the Statement of Verification, Agreement, and Consent.