As a participant in the Columbia State Community College TRiO Student Support Services Program, I am committed to my education. To gain the full benefits of the program, I will make a commitment to my academic goals and the assistance provided. I also understand the TRiO Student Support Services staff will review data from my application and interviews to assist in assessing my academic and career planning needs. Therefore, all information used will be kept strictly at the highest level of confidentiality. I give the TRiO Student Support Services Program staff permission to inquire about my class attendance, class work, and tutoring sessions and receive grade reports; and I give my instructors permission to release such information to TRiO Student Support Services staff when requested. Should I not meet the requirements and fulfill my academic goals, it may result in serious consequences regarding my continuation as a participant in the TRiO Student Support Services Program.
I authorize the TRiO Student Support Services Program staff to gather information concerning all my academic progress (standardized test scores, grade point average, earned credit, transcripts, tutoring, etc.) and financial aid status prior to my participation in the program. I also grant permission to the ADA Office to release information to TRiO Student Support Services if I fall under the disability
status. I understand that this information is used to help determine my eligibility for the program and will be kept strictly confidential. I grant permission for the TRiO Student Support Services Program to gather information for follow-up whenever appropriate, including, but not limited to, transfer and progress to four-year institutions. I am aware that my eligibility and financial aid status will be reported to the U.S. Department of Education in accordance with the grant funding regulations. I certify that the information provided on this application is true and complete to the best of my knowledge. I also agree to provide documentation upon request to verify the information reported.
I also hereby authorize the use of my photographic image in any and all publications, such as the monthly newsletter, newspaper articles, and campus-wide e-mail notices. I authorize Columbia State Community College to use my name, photo, or information about me in promotion of the college through radio, television, or other printed materials. I understand that my picture could come from a digital image such as my file or from photos taken on various field trips and social events. I am aware that personal information provided to the TRiO Student Support Services Program will be protected under the Federal Education Rights & Privacy Act (FERPA) of 1974. No one will have access to the information unless they work with or for Columbia State Community College and TRiO Student Support Services Program.