Certification and Authorization to Release information and Records

I certify that all the information provided is true and correct. I understand that information provided may be verified to help determine my eligibility for the program. I authorize the release of student records required for participation in the Friendly House Electrical Program. These records shall include but are not limited to all transcripts, grade point average, progress reports, attendance, withdrawal, standardized test scores, and class schedules. These documents and all information will be held in strictest confidence by Friendly House, Inc. staff.

I, the undersigned, do hereby consent and agree that Friendly House, Inc., has the right to take photographs, videotape, or digital recordings and to use these in any and all media, exclusively for the purpose of Friendly House Electrical Program.