Mason County Promise Zone Scholarship Renewal Application

This application is intended for those who are already utilizing the Mason County Promise Scholarship Dollars. This application will help us confirm all of your contact information and that you have maintained eligibility for the Promise Scholarship.

Consent Terms and Electronic Release:

I hereby authorize any school that I am enrolled in that participates in the Promise Zone Scholarship, through its agents and employees, to release any of my financial aid, attendance, demographic and/or academic record information, in whole or in part, to my local Promise Zone Authority/Organization coordinator, or his/her designee, to facilitate the analysis of my scholarship eligibility and the subsequent educational and economic impact of this scholarship.

As a recipient of a Promise Zone educational scholarship, that award information becomes part of my educational record. By consenting to receive any scholarship amount awarded to me, I agree to allow the release of this information in my educational record to third parties specified under the Family Educational Rights and Privacy Act (FERPA). FERPA affords certain rights to students concerning the privacy of, and access to, their education records. While this form authorizes my school, in conjunction with the local Promise Zone Authority/Organization, to release educational records to third parties, it does not obligate either entity to do so. My school reserves the right to review and respond to requests for release of my educational record on a case-by-case basis. For additional information, I can visit the U.S. Department of Education’s website at www.ed.gov/policy/gen/guid/fpco/ferpa/index.html.

The Promise Zone Scholarship can have several positive impacts on postsecondary enrollment, persistence, degree attainment and overall success in college. To understand these impacts, I authorize my postsecondary academic record information, in whole or in part, to be released back to my local Promise Zone Authority/Organization coordinator, or his/her designee, in adherence to FERPA for analysis to inform and improve the Promise Zone Scholarship program.

I also authorize my local Promise Zone Authority/Organization to use information regarding my scholarship in promotion of the Promise Zone Scholarship. The Mason County Promise Zone, and its entities, may be authorized to use my portrait, picture, photograph, name, voice and/or image on videotape, audiotape or film, or any other reproduction of me and to distribute and/or exchange copies of these to promote the program and the public schools of Mason County. No compensation is offered in exchange for permission.

This release is authorized starting on the date of the electronic signature on this agreement and after scholarship receipt for statistical purposes. To rescind this Authorization, I understand that I must submit a written notification of rescission to my school. I will also notify my local Promise Zone Authority/Organization in writing of my decision to rescind my authorization. This rescission would result in the termination of my receipt of the scholarship.

My signature (or that of my parent/guardian if I am under the age of 18) electronically via date stamp indicates that I have read this Authorization to Release Educational Records form and that I authorize the release of educational records as described above.

Required Certifications

I certify that all information submitted in this application is accurate and true.

Yes

I agree to the acceptance terms of the Mason County Promise Scholarship Application.

Yes

I authorize the release of my educational records as required by the terms of the scholarship.

Yes

Book and materials are not currently covered by Promise funds. Students should plan for book and course material costs to be a personal investment.

Yes

Students will have a maximum of four years from the date of high school graduation, or from the date of issuance of a GED or its equivalent, to use Promise scholarship monies

Yes

Promise funds may be used to cover a maximum of 72 attempted credits, the equivalent to an Associate’s degree from West Shore Community College

Yes

Students must apply annually and remain eligible for federal aid under West Shore Community College's Student Academic Policy in or to remain eligible for the Promise

Yes

Students are eligible to use Promise to cover summer courses

Yes

Consent and Signature

Release and Consent: In addition to receiving and understanding the above information on terms, I also provide consent for all releases and statements above.

I consent

Electronic Signature via Date Stamp

Enter your electronic signature below: Please type your full name below (If an applicant is under the age of 18, please enter parent or guardian's name).