KHAN
Academy
Packet

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KHAN Academy Packet

Access College Foundation Student Release Form

Student Name
Student Name
First
Middle
Last
Address
Address
City
State/Province
Zip/Postal

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.

X
Type your name in the box above
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Parents must sign if students are younger than 18 years of age.

*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.

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