Federal regulations require documentation of family income and educational attainment to determine eligibility.  We cannot accept applications without proof of income or a signed statement verifying income.  The information you give us will be kept confidential and is protected by the Federal Privacy Act, HIPPA Act, FERPA and COPPA.

S645.4 (i) In compliance with Sec. 402A€ 1070a-11of HEA, I hereby certify that the information I have furnished regarding the size of my family and taxable income is true to the best of my knowledge.

The Southern University at New Orleans Educational Opportunity Center Program is a federally funded TRIO Program and all services are provided to program participants free of charge.  All individuals who meet the eligibility requirements of this program are provided information regarding financial and academic assistance necessary for them to enter higher education for the first time or to return if they have dropped out. All information is confidential.

INFORMED CONSENT:

I {main_name} have read and I understand the provided information and have had the opportunity to ask questions. I understand that my participation is voluntary and that I am under no legal obligations. I understand HIPAA, FERPA, COPPA and Federal Privacy Act protect all information provided by me.

MEDIA AUTHORIZATION:

I, the undersigned, hereby grant Southern University at New Orleans Educational Opportunity Center and the university the right to use and publish photographs or videotapes of me, or in which I may be included, for editorial, advertising, and any other purpose and in any manner (publications, promotional media, social media, website, and/or news) without restriction.  I hereby release photographer from all claims and liability relating to said photographs (for example, the programs use photos for brochures or promotional videos).

EDUCATION RECORDS CONSENT:

I hereby consent to the release of my (participants’) education records (transcripts, grades, test scores, status of student, degree earned, and other information regarding my academic performance) to Southern University at New Orleans Educational Opportunity Center TRIO Program.  The TRIO program is required to provide an annual performance report to the U. S. Department of Education with data obtained from individual student records, which allows for the continuation of funding to offer free services.  I understand that the information in these records will only be used to assess the student’s need for the program services, evaluate the effectiveness of program activities, and fulfill federal program reporting requirements.  Furthermore, I hereby give the TRIO programs permission to forward my information to other programs and/or department with Southern University at New Orleans System whose services will best meet my needs.

Equal Opportunity Statement

This institute, in compliance with Title VI and VII of the Civil Rights Act of 1972, and the Federal laws and regulations, does not discriminate on basis of race, color, national origin, sex, age, religion, handicap, or status as a veteran in any of its policies, practices, or procedures.  This includes, but is not limited to admissions, employment, financial aid and educational services.