I, the undersigned below, authorize the release of my personal information, including but not limited to my name, date of birth, social security number, contact information, proof of residency, proof of income, and any other relevant information, to Black Boys in Tech for purpose of securing funding for my child’s participation in the program.
I also consent to the release of my spouse’s (if applicable) and children’s information, including but not limited to their name, date of birth, social security number and any other relevant information, to Black Boys in Tech for purpose of securing funding for my children’s participation in the program.
I further consent to the release of the aforementioned information to Black Boys in Tech and their third-party affiliates including the Ohio Department of Education, Merit International Inc., and A.M. Enterprises LLC for the purpose of applying for funding.
Further, I give permission to Black Boys in Tech to process my ACE Ohio application on my behalf using the information that I have disclosed in this application.
I certify that I am at least 18 years of age and have read and fully understand the contents of this form. I agree to the terms and conditions of this consent by signing below.