Upward Bound - Records Release Form

I give my permission for John Wood Community College Upward Bound personnel to obtain my records from the following high school:

I give my permission for John Wood Community College Upward Bound personnel to obtain my records from the following high school: Griggsville-Perry Meredosia-Chambersburg Pittsfield Quincy Senior High Other Other
Records to be obtained include the following: quarterly grade reports, class schedules, official transcripts, test scores, and any other related information necessary for my participation in the Upward Bound program. I understand this permission to release any and all pertinent information will remain in effect from the date signed on this form through high school graduation, and also for six years after I have ceased my participation in the John Wood Community College Upward Bound program.

I also give my permission to John Wood Community College Upward Bound personnel to view and obtain John Wood Community College transcripts, schedules, test scores, and financial aid records from John Wood Community College while enrolled as a college student and for dual credit while in high school.
Student name Student name First Last
Student birthdate Student birthdate / MM / DD YYYY
Student's social security number (last 4 only)
Must be 4 characters. Currently Entered: 0 characters.
Student signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Parent/Guardian name Parent/Guardian name First Last
Parent/Guardian signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.