I verify that all the information on this form is accurate and complete to the best of my knowledge. I understand that all information provided will be kept confidential and will be used to determine eligibility and services needed. I hereby give the KEYS Program permission to obtain information regarding my financial and academic status. If I identify a disability, I grant permission to the AWC AccessABILITY Resource Services to release necessary information to KEYS Program staff for the purpose of verifying eligibility. If accepted, I will participate as required by the KEYS Program. I also grant the KEYS Program my permission to use my photograph, image, and videotape, or otherwise record of my participation in program activities and to reproduce and use such recordings. I hereby grant permission to KEYS Program to use my name, likeness, voice and/or biographical information with any media format which includes, but is not limited to: non-commercial promotional activities, newspapers, magazines, television, radio, film, and/or on the internet. Also, my consent is freely given as a public service to KEYS Program without expectation of payment. I understand that KEYS program is required to transmit my personal information to the U.S. Department of Education. Specific individual information reported on me can be found in Section III of the KEYS annual report and contains information such as my name, SSN, cum. GPA, academic standing, biographical information, and financial aid information.
