SCHOOL RECORD CONSENT
Upward Bound Program
University of Hawaii at Hilo
200 W. Kawili Street
Hilo, HI 96720-4091
Ph: (808) 932-7517 Fax: (808) 932-7515
Please read and initial each statement:
I understand that as part of the Upward Bound application process my child’s school records
including grades and test scores (and IEP, if applicable) will be provided.
I understand counselor and teacher recommendations and evaluations of my child must be
provided.
I understand that if my child is selected for the program, the program will continue to require the
information mentioned above throughout my child’s participation in the Upward Bound program or
as required by the U.S. Department of Education.
Please print clearly and provide signature:
Student’s Name: ____________________________, ____________________________ ____
Last First MI
Student’s Signature: ____________________________________________________________
Parent/Guardian Name: ______________________________, __________________________
Last First
Parent/Guardian Signature: ______________________________________________________
8/20/15
