Authorization and Disclosure Consent:
I authorize any of the participating institutions in the Birmingham Promise program to receive, release and share any and all of my financial aid, demographic, or academic information, in whole or in part,
to the Birmingham Promise Program, including Birmingham Promise, Inc., and its staff and contractors, participating colleges, universities and employers and Birmingham City Schools and its individual schools, for the purpose of facilitating analysis of my eligibility for the Promise program and any applicable benefits and the operation and educational and economic impact of the program on the City of Birmingham. The information to be shared may include:
- home address
- email addresses
- telephone number
- date and place of birth
- major field of study
- grade point average
- number of credit hours per semester
- dates of enrollment
- degree(s) awarded.
This release is authorized for the duration of the time that I receive scholarship funds or otherwise remain a participant in the Promise program. In order to rescind this Authorization, I acknowledge that I must submit written notification of rescission to Birmingham Promise, Inc. This rescission may result in the termination of my receipt of benefits of the Promise program.
I understand that I have the right to request a copy of any records disclosed or shared.
I understand that a requirement to receive funding includes adhering to the Promise conditions, which include: graduating from a Birmingham City Schools high school, successfully completing the FAFSA every year, successfully applying to participating institutions, gaining admission to a participating institution, completing the Birmingham Promise registration form in its entirety, providing the Birmingham Promise with accurate contact information, and participating in any mandatory programming as set forth by my chosen institution within the deadlines set forth by the Birmingham Promise and the participating institution. Additionally, I understand that the Birmingham Promise will meet the costs of tuition and fees only, and will only do so after Pell grants and all other non-loan financial aid have been applied at participating institutions.
Furthermore, I am aware that I must maintain full-time status as a student or complete at least 24 credits in a school year and maintain satisfactory academic progress and satisfactory academic standing as defined by Pell grant regulations at the participating institution of my choice. I am aware that failure to adhere to these requirements may result in the termination of my receipt of this promise.
I understand that Birmingham Promise will be evaluated by a third party researcher. I understand that, as part of this evaluation, the Birmingham Promise will share my student record data (including personal identifiers) and program participation data with the evaluator. I understand that Birmingham Promise will also collect data from the National Student Clearinghouse, which has information on enrollment and degrees received at most colleges in the country. I also understand that Birmingham Promise may collect earnings and employment data from state employment agencies. I understand that Birmingham Promise may collect these data for up to 10 years. I understand that any information that Birmingham Promise collects for the study will be kept confidential and will be used for research purposes only. In addition, I understand that Birmingham Promise may contact me to participate in a survey, interview, or focus group about my experiences in college. Furthermore, I give permission to the Birmingham Promise to use information, including records, photos, interviews, videos and images in promotion of the Birmingham Promise.