Educational Release

The Educational Records Release and Permission to Photograph Form is the application required for Pokagon citizens of all ages to become eligible for programs and services provided by the Department of Education.  

Purpose:  To offer educational services to Pokagon Citizens who are both inside and outside of the 10 County Service Area. This form provides the department with pertinent data, gives permission for staff to access necessary educational information, and determines whether or not permission is granted for students to be photographed. 

Policy:

Eligibility Requirements 
Must be a Pokagon citizen

Time Frame: August 1 – July 31

  • A current form must be submitted to the Department of Education each year for the citizen to be eligible to apply for any programs or services offered by the department.

Guidelines

  • Students who are enrolled in Pre-K (must be 4-years-old by September 1 of the current year) through 12th grade will receive a check for $150 per school year once the Release Form is processed. This money is for purchases which will aid the student academically. (A W-9 Form is required to receive payment.)
  • Students who are enrolled in Pre-K through doctorate level studies will be eligible to apply for suitable programs through the Department of Education once the Records Release Form is completed for the current year.

Procedure:

  1. New Records Release Form becomes available during the summer of the upcoming school year (date to be determined each year as applicable).
  2. Legal Parent fills out the form for the minor student, including a W-9 Form.  Adult students complete form and W-9 for themselves.
  3. If student is in the Ten County Service Area and attending public school, fill out Title VI form (below).
  4. Completed form is turned into the Department of Education.
  5. Beginning August 1, a check for $150 per student who is enrolled in Pre-K (must be 4-years-old by December 31 of the current year) through 12th grade is mailed to the legal parent for the purchase of academic supplies.
  6. The stipend is recorded in the PreK-12 database for the student.
  7. Student is added to Education database and is then eligible to apply for programs offered by the department.
AttachmentSize
Educational and Photo Release Form 2017–201893.66 KB
W-9 form109.59 KB
Title VI form219.09 KB