I hereby authorize any school, skilled trades, certificate, and apprenticeship program that I am enrolled in that participates in the Promise Zone Scholarship, through its agents and employees, to release any of my financial aid, attendance, demographic, and/or academic record information, in whole or in part, to the Pontiac Promise Zone Executive Director, Program Coordinator, or Administrative Assistant, to facilitate the analysis of my scholarship eligibility and the subsequent educational and economic impact of this scholarship. As a recipient of a Pontiac Promise Zone scholarship, that award informant becomes part of my educational record. By consenting to receive any scholarship amount awarded to me, I agree to allow the release of this information in my educational record to third parties specified under the Family Education Rights and Privacy Act (FERPA). FERPA affords certain rights to students concerning the privacy of and access to heir educational records to third parties. While this form authorizes my school, in conjunction with Pontiac Promise Zone, to release educational record to third parties, it does not obligate either entity todo so. My school reserves the right to review and respond to requests for release of my education records on a case-by-case basis. For additional information, I can visit the U.S. Department of Education's website at: https://www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html
I also authorize the Pontiac Promise Zone to use information regarding my scholarship in promotion of the Pontiac Promise Zone scholarship.
This release is starting on the date of the signature on this agreement and after scholarship receipts for statistical purposes. To rescind this Authorization of Release, I understand that I must submit written notification of rescission to my school. I will also notify the Pontiac Promise Zone in writing of my decision to rescind my authorization. This rescission would result in the termination of my receipt of the scholarship.
My signature (or that of my parent/guardian if I am under the age of 18) below indicates that I have read and understand this Authorization of Release, and that I authorize the release of my educational records as described above.