KHANAcademyPacketFill out the form below. It will automatically sent to your advisor.KHAN Academy Packet Access College Foundation Student Release Form High School * Bayside High School Booker T. Washington High School Churchland High School Frank W. Cox High School Deep Creek High School First Colonial High School Granby High School Grassfield High School Great Bridge High School Green Run High School Hickory High School Indian River High School Kellam High School Kempsville High School King's Fork High School Lakeland High School Lake Taylor High School Landstown High School Manor High School Maury High School Nansemond River High School Northampton High School Norview High School Ocean Lakes High School Oscar Smith High School Princess Anne High School Salem High School Tallwood High School Western Branch High School Graduation Year * Student Name * Student Name First First Middle Middle Last LastAddress * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Student Personal Email Address * Phone * Birthday * The Access College Foundation helps find financial aid for your student to attend college. Your permission is needed to request information from a variety of sources that will verify the student’s financial aid, grades, transfer records or any other relevant information. Access will be gathering this information for statistical purposes and to aid in the financial aid process. All information will be held in confidence per the requirements of the Family Educational Rights and Privacy Act (FERPA) and as defined by the Code of Virginia, Title 22.1. Education for “School-affiliated entities.” This authorization shall be valid for a period of six years from the high school graduation date.The Access College Foundation may take photographs and/or video footage of Access students during Access activities to use in publications (such as our Annual Report, newsletter, etc.) and promotional videos.I authorize the release of any and all information related to financial aid, grades, transfer records, or any other information necessary to ACCESS College Foundation for the purpose of receiving services. I also authorize the public use of any pictures that may be taken during an ACCESS event. Student Signature * XType your name in the box above Date * Parent Signature XParents must sign if students are younger than 18 years of age. Date *Note: A Social Security Number is not required to obtain services provided by Access; however, to advocate on the student’s behalf when speaking to college admissions or financial aid departments this number or the new FSA ID may be required as a student identifier. reCAPTCHA If you are human, leave this field blank. Next Start Over