Authorization to Release Student Information
Authorization is hereby given to the CSLA Upward Bound Programs to request and receive the information listed below from my child’s middle school, high school and the National Student Clearinghouse:
- Academic transcripts with current standardized test scores.
- Current cumulative records
- 5, 10, 15, and 20 week progress reports
- Fall Semester and Spring Semester Grades
- SBAC test scores
- SAT/PSAT/ACT Test scores
- Postsecondary Education Enrollment Verification
These records will be used for the following purposes:
- To determine academic need and program eligibility.
- To monitor on a regular basis the academic performance and progress of the participant named below throughout his/her participation in the program and beyond.
- Provide information to the U.S. Department of Education as part of the required annual performance report.
I understand and agree that the CSLA Upward Bound Programs will not allow a third party to have access to this information without the written consent of the participant’s parents/guardians.
I understand that by signing this form, permission is granted to use photos of the participant on the program’s social media, brochures and website. In addition, the CSLA Upward Bound program may also wish to use my child’s photograph, voice, or student work for promotional and educational reasons, such as publications, posters, newsletters, a radio station, a Cable TV channel, or at community fairs.
I understand the purpose of the Upward Bound Program, which is to prepare participants to successfully complete a program of postsecondary education, and I would like to have my child participate. I agree to be involved in the following ways: (1) staying informed of my child’s progress in school; (2) encouraging my child to attend all UB activities; (3) participating in UB events in which parents are invited; (4) sharing concerns about my child’s education with UB staff.
I hereby certify that all the information provided in this application packet is true and correct. I understand that a false statement or misrepresentation will make the applicant ineligible for the CSLA Upward Bound Program.