College Possible Senior Academic Release

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Academic Release
I release all academic and financial information to a College Possible representative. This information may include academic charges/credits/payments, grades, registration, academic progress, enrollment, financial aid application and awards, and demographic information. In addition, I request that College Possible have access to view my academic record through college graduation. This information will be used by College Possible staff to verify student information and provide programmatic support.

The Family Educational Rights and Privacy Act of 1974 prohibits the release of personally identifiable information from student’s educational records without their prior written authorization. Exceptions to this policy are limited to: (1) release of such information to a specific list of officials with a legitimate educational interest in the record, (2) the release of such information in response to a court order, health or safety emergency, or approved research project, or (3) the release of public directory information which has not been previously restricted by the student.

Records to be disclosed:
Semester grade point average, cumulative grade point average, semester hours/credits enrolled, semester hours/credit attempted, enrollment status, academic standing, degrees awarded or conferred, financial aid reports, financial aid application status

Parties to whom the records may be disclosed:
College Possible staff

Purpose of Disclosure:
For use in College Success services offered to College Possible students for academic and financial support and management

Length of Disclosure:
This authorization shall begin and end on the date listed below:
Begin Date: July 1, 2024
End Date: June 30, 2034

Student Information

Select your College Possible site

Legal first name

Legal last name

First name

Middle name

Last name

Birthday

If your DOB is in January-September, enter M/DD/YYYY. If your DOB is in October-December, enter M/DD/YYYY.

Gender

Preferred pronouns

Contact Information

Which email address do you check most often?

Permanent address - street

Permanent address - city

Permanent address - state

Permanent address - zip code

Post-Secondary Plans

Which college will you be attending next year?

College ID Number

Please share your College ID number if you know it.

Academic Release

Please mark below if you agree to give College Possible permission to share my name, demographic and contact information with my high school, partner colleges or other organizations. This information will only be shared for the purpose of connecting College Possible students with additional resources.

I agree

Media Release

Media Release: College Possible recognizes that when publishing a student’s photograph, quotation or written work, particular attention and responsibility must be given in order to protect student identities. Therefore, College Possible has established the following guidelines for publishing information about students. Please review the guidelines carefully. Student or parent/guardian permission is necessary before a student’s photo, quotation, or work can be published. • Photographs and quotations taken during official College Possible activities (program-sponsored community service events, campus visits, and other program events) will be used in print and electronic publications. • A student’s first name and last initial may be included with photographs, quotations, or written work. • Additional written permission from the student or parent/guardian will be required prior to publication if College Possible chooses to publish a sample of their written work.

YES, I have read the above guidelines and give College Possible permission to publish the name, photographs, and statements of or made by me I also hereby release and discharge College Possible and individuals persons employed/contracted by them to obtain these photographs and testimonies, from any and all claims, demands, and causes of action and suits arising out of or in connection with the use of photographs, quotations, or written works, including any and all claims for libel and invasion of privacy.NO, I do not want the name, photographs, and statements of or made by me to be published in College Possible materials. I understand that by choosing this option, it is the student’s responsibility to avoid appearing in any photographs taken during his/her participation in the program and to state this intention to the photographer any time photographs are taken.

Contact Information

Records to be disclosed:	Semester grade point average, cumulative grade point average, semester hours/credits enrolled, semester hours/credit attempted, enrollment status, academic standing, degrees awarded or conferred, financial aid reports, financial aid application status
Parties to whom the records may be disclosed:	College Possible staff
Purpose of Disclosure:	For use in College Success services offered to College Possible students for academic and financial support and management
Length of Disclosure:	This authorization shall begin and end on the date listed below: Begin Date: July 1, 2024 End Date: June 30, 2034