ACCESS Services Application 2024-2025

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Page 1

ACCESS may be able to provide assistance in covering fees for SAT registrations, ACT registrations, up to four college applications, AP Testing, NCAA Clearinghouse, and CSS Profile. Complete this form to determine your eligibility. This will also help your Advisor find scholarships that you may be eligible for.
Student Name




Student Address




Student Information



MM/DD/YYYY or MM-DD-YYYY






Parent/Guardian Information






Please tell us about your family income

Numbers and decimals only for these questions. No other characters.


If no income, please put "0."

Other Benefits

Per month

Per month

Per month

Per month

Please tell us about any special circumstances that apply to your family:



By typing your name, you acknowledge the identity of the signer and agree to sign electronically.

Page 2

Student Information Release


MM/DD/YYYY or MM-DD-YYYY

The ACCESS College Foundation helps find financial aid for your student to attend college. Your permission is needed to request information from a variety of sources that will verify the student’s financial aid, grades, transfer records or any other relevant information. This includes but is not limited to: the CSS Profile and financial aid verification documents. The FAFSA requires a separate consultation form to
be completed. 

ACCESS will be gathering this information for statistical purposes and to aid in the financial aid process. All information will be held in confidence per the requirements of the Family Educational Rights and Privacy Act (FERPA) and as defined by the Code of Virginia, Title 22.1. Education for “School-affiliated entities.”

This authorization shall be valid for a period of six years from the high school graduation date. 

The ACCESS College Foundation may take photographs and/or video footage of ACCESS students during ACCESS activities to use in publications (such as our Annual Report, newsletter, etc.) and promotional videos.

I authorize the release of any and all information related to financial aid, grades, transfer records, or any other information necessary to ACCESS College Foundation for the purpose of receiving services. I also authorize the public use of any pictures that may be taken during an ACCESS event.

By typing your name, you acknowledge the identity of the signer and agree to sign electronically.


By typing your name, you acknowledge the identity of the signer and agree to sign electronically.

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