(To Be Completed by Parent/Guardian.  Please note the following information is required)

Please provide a copy of any documentation verifying your income (i.e. 2019 1040 tax documents, non-tax filer’s form, SSI benefits statement, etc.). Although income verification is required to complete each clients’ file, your income does not determine your child’s acceptance into the program. Note: Taxable Income is usually lower than Adjustable Gross Income which is located at the bottom of the first page of most tax forms.  Annual Taxable Income can be found on page 2 of most tax forms.  Please call 256.372.4600 if you have any questions or need assistance locating this information.

RELEASE OF SCHOOL RECORDS

I authorize the North Alabama Center for North Alabama Center for Educational Excellence Educational Talent Search Program (ETS) to obtain and receive copies of my student’s academic records, counselor’s reports, and any other academic information necessary to complete the program’s application. I further grant ETS the right to utilize media resources (e.g. Facebook, Twitter, email, digital video/cameras, etc.) for services which promote, advance, and adhere to the federal mission of ETS.

I certify that all information provided above is correct and true to the best of my knowledge.

Please note that all applications are accepted for review regardless of race, color, national origin, religion, gender or disability (U.S. Dept. of Education – GEPA Section 427).

North Alabama Center for Educational Excellence     

Educational Talent Search Program

Educational Plan (EP) 2023-2024

SERVICE PLAN STATEMENT

NACEE Educational Talent Search Program (NETS) participant will be offered project services for the appropriate grade-level based on the “Student Needs Assessment.”  These services will be provided either through academic advising, career counseling, various workshops, and/or guest speakers.  They are designed to help participants transition to the next grade, complete high school, and enroll in the postsecondary educational institution of their choice.

NORTH ALABAMA CENTER FOR EDUCATIONAL EXCELLENCE

PARENTAL CONSENT FORM

PARENT/GUARDIAN INFORMATION

PERSON(S) AUTHORIZED WITH WHOM CHILD MAY BE RELEASED

EMERGENCY CONTACT WHEN A PARENT/GUARDIAN CANNOT BE REACHED

MEDICAL INFORMATION

We authorize the North Alabama Center for Educational Excellence (NACEE) employees to render any medical care and treatment to our child/ward deemed necessary with respect to any illness or injury occurring during any activities.  I (we) understand that the NACEE has no medical coverage and I (we) agree to pay additional medical costs incurred.  I also understand my child may be photographed or interviewed by media during NACEE activities.

I understand that neither NACEE nor its staff is obligated to provide transportation in connection with the Program.  I understand that I am expected to carry my own automobile liability insurance coverage if driving on premises or to scheduled events.

Assumption of Risk and Release of Claims:  In consideration of being permitted to participate in the Program, I agree, on behalf of my family, heirs, and personal representative(s), to assume all the risks and responsibilities surrounding my participation in the Program.  To the maximum extent permitted by law, I release the indemnify NACEE and its staff from and against any present or future claim, loss or liability for injury or injuries to person or property which I may suffer, or for which I may be liable to any other person, during my participation in the Program (including periods in transit).

RELEASE OF SCHOOL RECORDS

I authorize the North Alabama Center for Educational Excellence Educational Talent Search Program (NETS) to obtain and receive copies of my student’s academic records, counselor’s reports, and any other academic information necessary to complete the program’s application. I further grant NETS the right to utilize media resources (e.g. Facebook, Twitter, email, digital video/cameras, etc.) for services which promote, advance, and adhere to the federal mission of NETS.

I have carefully read this Release form before signing it.  No representations, statements, or inducements, oral or written, apart from the foregoing written statement, have been made.  This agreement shall become effective only upon receipt by the North Alabama Center for Educational Excellence at its offices in Alabama and shall be governed by the laws of the state of Alabama.