Harcum College TRIO Upward Bound Application

RELEASE OF SCHOOL RECORDS
Student Name

First NameLast Name
Harcum College Upward Bound Program has permission to obtain copies of school records for the student named above. These records may include, but are not limited to: (Please select all 3)

TranscriptsScores for standardized achievement and diagnostic test/assessmentsOther Reports or academic data necessary for admission and participation in Harcum College Upward Bound Program
We authorize the release of these records for the period of the student's school attendance from grade 7-12 until we rescind this permission in writing.
Parent Signature *

Clear
Date

MonthDayYear
Date
Student Signature *

Clear
Date

MonthDayYear
Date

Request for Taxpayer Identification Number and Certification

Form W-9
PLEASE MAKE SURE TO FILL OUT SECTION/NUMBER 1,3,5 & SSN. ALSO SIGNED AND DATED!!!

Give Form to the requester. Do not send to the IRS.
1 Name as shown on your income tax return Name is required on this line; do not leave this line blank.*
2 Business name/disregarded entity name, if different from above
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes.*

C CorporationIndividual/sole proprietor or single-member LLCS CorporationPartnershipTrust/estateLimited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)
4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3):
Exempt payee code (if any)
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)
5. Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security #*
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

HARCUM COLLEGE