Miami Gear UP Forms- 10th and 11th Only

Miami Dade College Kendall Campus/ Miami GEAR UP

Student and Parent/Guardian Consent Form

What is Miami GEAR UP? Miami GEAR UP stands for "Gaining Early Awareness and Readiness for Undergraduate Programs." It is a program funded by the U.S. Department of Education (Award P334A220101) that helps students prepare now for their future educational and career goals. Miami GEAR UP/Miami Dade College Kendall Campus, in partnership with Miami-Dade County Public Schools (MDCPS), will provide services and make information and resources available to help you and your student apply, pay for, and enroll in a postsecondary education program of their choice.

Miami GEAR UP is free to students and their parents! Miami GEAR UP students are eligible to receive support services in middle school, high school, and through their first year of college. These services are designed to inform students about educational opportunities after high school. Services will be provided at the school site, the Miami Dade College Kendall Campus, and at field trip sites.

What does the Miami GEAR UP program do? Miami GEAR UP provides support services and information during the school year and summer to help students be successful in school, gain information on potential careers, and understand how to financially plan for education after high school. There are many activities included in our program: tutoring, college visits, career exploration, mentoring programs, financial literacy workshops, summer camps, and student/parent engagement events.

Participation in Miami GEAR UP is voluntary. Participation is voluntary in all events and services. Students can withdraw at any time without penalty. Before each event, Miami GEAR UP staff will remind students of these rights before administering any questionnaires or starting any focus groups. Throughout the Miami GEAR UP program, students will be asked to participate in surveys and focus groups that will help the staff better understand how well the services we are providing are working. These topics will be measured and reported to the Department of Education to evaluate the program's efforts in reports, publications, and presentations that are available to you upon request. The risks expected as a result of participation in Miami GEAR UP surveys or focus groups are not beyond those that exist in everyday life.

As part of the program, Miami GEAR UP will provide students and parents/guardians with services related to postsecondary education and career exploration. Miami GEAR UP will not give out information specific to your child or share your contact information with any third parties and any data collected will be used for evaluation purposes.

(305) 237-0303 MiamiGEARUP@mdc.edu

Dr. Lisa Gonzalez Miami GEAR UP, Director (305) 237-2591 Ldecast1@mdc.edu

Miami Dade College IRB (305) 237-7445 IRB@mdc.edu

Form Information
Student Name

First NameLast Name
Student ID
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian Consent
Print Parent/Guardian Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian Signature
Parent/Guardian/Preferred Contact Mobile Number
Format: (000) 000-0000.
ParentGuardian Email
example@example.com
Student Consent
Student Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

STUDENT SUCCESS AGENCY
Miami GEAR UP can provide your child supplemental on-line/ virtual services to support classroom learning and development. This support will be provided by a third- party agency: Student Success Agency.

I do give my parental consent. I understand and give permission for my child to use this service, which provides help with mentoring, career questions, coaching, applying to college, or just helping with questions in daily life to be a successful student. I understand that my child will be connecting virtually with a college-going student/mentor. All mentors go through a 5-step interview process and background check. Personal numbers will NOT be exchanged between your child and their mentor. THIS IS ONLY FOR STUDENTS 13 YRS. AND OLDER.
ParentGuardian Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

CONSENT FORM FOR MUTUAL EXCHANGE OF INFORMATION
I hereby authorize the mutual exchange of records pertaining to my child or myself, between the MIAMI-DADE COUNTY PUBLIC SCHOOLS and the following agencies

Miami GEAR UP Kendall Campus

Vela Insitutite

National Council for Community and Education Partnerships

Student Success Agency (SSA)
4The specific records to be disclosed pertain to:

Grades, report cards, transcripts, FSA scores, IEP's, college readiness assessments attendance, SAT/ACT/PERT/Accuplacer scores, demographics, other relevant academic info.

The purpose for making these records available is: for reporting to the US Department of Education on grant performance; provide students and parents with resources to choose, apply, and matriculate into a college program The receiving party will not disclose the information to any other party without signed consent.

I certify that I am the parent or legal guardian of the child named above or that I am a student of majority age and have the authority to sign this release.
Parent/Guardian Signature
Address

Address

Street Address Line 2

City StateState / Province

Zip Code

Permission for Release of Records and/or Information From Records
Records to be released: Test Scores, Attendance Informaiton, Grades and Demographics,

The record(s) indicated above is/are to be released to: Miami Gear UP

Address 11011 S.W. 104 St. Rm. R243, Miami, FL 33176

The purpose for this release is: to provide students/parents with information on postsecondary education success.

I hereby grant permission for the release of the above record(s) and this release is to be in effect until 09/30/2028.
Signature of Parent or Guardian
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Miami-Dade County Public Schools is subject to the Family Educational Rights and Privacy Act of 1974 Codified at 20 U.S.C. §1232 g. Therefore, all documents contained in a student's educational records, except those specifically waived, are accessible to the parents or eligible student.

Personally identifiable information may be transferred to a third party only on the condition that it will not be released to any other parties without obtaining the consent of the parent or eligible student.
A COPY OF THIS AUTHORIZATION SHALL BE AS VALID AS THE ORIGINAL

Film and Photography Consent and Release

I acknowledge that I am 18 years old or older* and hereby voluntarily give my consent to the District Board of Trustees of Miami Dade College, Florida ("College") as follows:

1. To record my likeness, voice, art work, possessions and other content in any medium, including, but not limited to: print, video, audio, photograph, digital, electronic or any other method of publication/communication (collectively referred to as "Recordings"); and

2. To use, reproduce, exhibit, distribute, advertise, broadcast, edit, promote, record, webcast, podcast, market or otherwise commercially utilize any or all of these Recordings, in whole or in part, in perpetuity by any and all means, media, devices, processes and technology whether now known or hereafter developed, including, but not limited to, television, radio, online/internet, mobile, wireless, theatrical and home distribution, sound recording, publishing, commercial, and merchandising.

I understand that these Recordings may be used for commercial purposes, but solely for the use of the College. The College may edit, use and republish/rebroadcast such Recordings for educational purposes including, but not limited to, use as classroom instruction; closed-circuit television or digital transmission on campus, MDCTV, or to off campus class meetings, assemblies or events; independent instruction; recruitment; marketing and promotion; news and, any other purposes of the College. I explicitly waive any rights I may have under the Family Educational Rights and Privacy Act ("FERPA") and/or § 1002.22, Fla. Stat., or any other right to privacy as it relates to these Recordings.
* If under the age of 18, please have a parent or legal guardian fill out the following:
Signature of ParentGuardian
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Form Information

STUDENT SUCCESS AGENCY

CONSENT FORM FOR MUTUAL EXCHANGE OF INFORMATION

Permission for Release of Records and/or Information From Records

A COPY OF THIS AUTHORIZATION SHALL BE AS VALID AS THE ORIGINAL