Upward Bound Release of Records Authorization

RELEASE OF RECORDS/CERTIFICATION & AUTHORIZATION

 

RELEASE OF SCHOOL RECORDS

 

I hereby authorize the City of Seattle Upward Bound Program to obtain student transcripts, grades, test scores, attendance, class progress reports, free reduced lunch eligibility, immunizations, etc. from Seattle Public Schools as long as my student participates in the program. I also authorize the City of Seattle Upward Bound Program to release such records to other institutions as they relate to my student’s educational program. These records will be used to assess student needs, monitor student progress, document program eligibility, and report data required by the U.S. Department of Education. All information will be kept confidential. The information shall only be transferred to a third party outside the Center for Educational Access and Outreach and the Upward Bound Program on the condition that consent of the parent/guardian (or applicant, if over 18) is first obtained.

PHOTO AUTHORIZATION

 

I hereby authorize the City of Seattle Upward Bound Program to use photographs of my student in its public education materials and news releases. I understand these photographs will not be sold or used for commercial purposes.

PERMISSION FOR FIELD TRIP PARTICIPATION

 

I hereby give my student (if selected) permission to participate in the following Upward Bound activities; tutoring, field trips, educational/cultural events, and a six-week summer program at a college/university. Also, I understand that this opportunity to participate involves normal risks and I am willing to assume the risks and hazards to such participation. I agree to hold the City of Seattle and the Upward Bound Program harmless for any accident that may occur, as long as reasonable precautions are taken to ensure the safety of my child.

GRIEVANCE PROCEDURE

 

In line with the City of Seattle Upward Bound Program CODE OF CONDUCT, you have the right to be treated with respect at all times. Upward Bound Staff is to exhibit the highest standard of personal and professional behavior while performing their job duties. If you feel your rights have been violated, you are dissatisfied or have any complaints with the program the following steps are to be taken for resolution:

1) Talk to the person you have a concern with

2) If satisfaction is not achieved, talk with the Upward Bound Director

3) If satisfaction is not achieved, talk with the Upward Bound Director’s Supervisor

4) If the above procedures fails to address your concerns, you may proceed with the City of Seattle’s grievance system and/or seek legal counsel

I have read and understand the above grievance procedure to be followed if I feel that my rights have been violated.

CERTIFICATION OF ACCURACY

Our signatures below indicate that to the best of our knowledge, the information provided on this application is true, complete and accurate.