1. Grant Funded Student's Authorization to Disclose Information from Education Records

I understand that my educational records are protected by the Family Educational Rights and Privacy Act of 1974, and they may not be disclosed without my prior written consent. I hereby consent to the disclosure of the following education records pertaining to me to the persons and for the purposes as stated below:
I hereby authorize the following officials:
1. Bossier Parish Community College (BPCC) college officials and faculty members teaching courses in which I am currently (or was) enrolled
2. Advanced Manufacturing Mechatronics and Quality Consortium, Employment Training Administration (ETA), and Louisiana Community and Technical College System (LCTCS).
3. The TAACCT3 third-party evaluator (Social Policy research Associates-SPR)
4. Louisiana Economic Development (LED)
5. The U.S. Department of Labor

to disclose the following:
1. demographic or contact information, which may include social security number and other personally identifiable information
2. employment status including wage information
3. financial information, including financial aid, student account balance, and Veterans benefits
4. academic records including, but not limited to placement test results, class schedule, interim and final grades, attendance, and any information regarding my academic progress prior to the final determination of grade
5. Completion, and post-program employment (including demographic date and social security numbers)

to the following persons:
1. Advanced Manufacturing Mechatronics and Quality Consortium, ETA, LCTCS
2. Specific state and federal grant funders, lead agencies, fiscal administrators of grant programs
3. BPCC college officials with a legitimate educational need to know
4. The TAACCCT3 third-party evaluator (Social Policy Research Associates-SPR)
5. Louisiana Economic Development (LED)
6. The U.S. Department of Labor

for the following purposes:
1. to monitor, assist and determine eligibility for grant-funded programs
2. to monitor and assist with respect to retention and student support needs related to programs within Student & Career Services
3. for reporting requirements of specific grant programs; as well as for statistical analysis of grant outcomes
4. to monitor and assist with graduate placement needs and employment outcome tracking
5. specified reporting and evaluation purposes
6. to collect information from state and federal agencies about my employment and earnings; SPR may use my social security number (SSN) to obtain this information.

I understand that:
1. SPR may contact me to ask me to complete a brief online survey regarding my program experiences and to request suggestions about how the program can be improved. I understand that my participation in the survey will be completely voluntary and my responses will be confidential.
2. This consent also includes authorization for the use of my photos and information in program publicity and student success stories.
3. I further certify that I am not in default of any federal student loans.

I further understand that:
1. such records may be disclosed only on the condition that the party to whom the information is disclosed will not re-disclose the information to any other party without my written consent unless specifically allowed by law.
2. I have the right to not consent to the release of my educational records for these purposes only by initialing the box below.
3. I recognize that a copy of such records must be provided to me upon my request in writing to the BPCC Registrar.
4. this authorization remains in effect unless revoked by me in writing.
A copy of this authorization shall be considered as effective and valid as the original.


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