Disclosure of Educational Records

I {main_name} hereby authorize my postsecondary institution and/or the National Student Clearinghouse to release my educational records including personally identifiable information including but not limited to, my name, my email address, my address or family address, social security number, student number, or date of birth. Educational records may include but are not limited to grades, transcripts, student course schedules, student financial and financial aid information, and student enrollment and graduation records. The information may be recorded in any way, including, but not limited to, handwriting, print, computer media, videotape, audiotape, film, microfilm, microfiche, and e-mail. The purpose of this disclosure of my personally identifiable information and educational records is to enable TRIO College Programs program to comply with federally mandated reporting requirements of the TRIO College Programs.

Photo/Video Release & Authorization Form

I {main_name} give and authorize the University of Southern Maine, a campus of the University of Maine System, (“USM”) the right to use, display, copy, license or assign photographs and video footage of my image and voice, as recorded, photographed, taped and/or filmed during or in connection with the following program, activity or event: TRIO College Programs for use in informational, promotional or commercial websites, publications and materials published by, or on behalf of, USM in photographic, print, video, electronic, digital or any other medium, including the Internet, (all of which are included in the term “Material”), and to do so with or without mention of my name, all in consideration of being included in the Material.

USM shall have the exclusive right to license and use the Material as USM wishes, including, but not limited to, the rights of copying, performance, public display, reproduction and distribution in all media, and the right to create, perform, display and distribute derivative works of the Material, for any purpose.

I understand I have the right to revoke this authorization at any time. I understand that if I want to revoke this authorization I must do so in writing and present my written revocation to the USM TRIO College Programs Office. I understand the revocation will not apply to any Material that has already been printed or published prior to USM’s receipt of my written revocation, but will apply only to future Materials.

I agree that I shall be solely responsible for any and all damages and costs on account of property damage or personal injury to me or other people that I may cause by my words or actions in connection with my appearance and/or the use of the Material, and I release USM from any responsibility for such costs or damages.

I request that this Release and Authorization be construed and interpreted under the laws of the State of Maine, and if any part of it is determined to be invalid, I request the rest of it continue in full force and effect. I completely understand and have fully informed myself of the terms and conditions of this Release and Authorization by having read it, or having it read to me, before signing and I intend to be fully bound by it.

This form is voluntary to complete. I understand if I wish to revoke the release, I must do so in writing and give my written revocation to TRIO College Programs Office.

Income Levels

Do you meet any of the following conditions?

• I am married
• I am currently earning a graduate degree.
• I am a veteran or I am currently on active duty in the military.
• I am in foster care or I have lost both parents after the age of 13.
• I am legally emancipated from my parents/guardians.
• I am homeless or deemed at risk for homelessness by an approved official..
• I am responsible for a child/dependent who receives more than half of their support from me, the student.
• I will turn 24 before January 1st of the school year I am applying for