By submitting this form, you agree that:

1.  All of the information is true and correct to the best of your knowledge.

2.  Your legal guardian gives their consent.

3.  I give permission to St. Petersburg College, on behalf of St. Pete Works and the City of St. Petersburg, to obtain and/or disclose my past, present, and future information or records that may be needed for eligibility determination, monitoring, and follow-up purposes. This information may include, but shall not be limited to school records, grade records, attendance records, employment information, medical records, public assistance records, employment information, and vocational rehabilitation assessment or evaluation tools.  You understand that any information obtained will be held in strict confidence. You understand that you may revoke consent to obtain or disclose your information at any time by providing a written statement indicating that your consent to obtain or disclose information is no longer given to the parties previously granted permission.

4.  I understand that each agency offers different programs and must have specific information to provide services and benefits. By submitting this form, I allow St. Petersburg College, Gulf Coast JFCS, and the City of St. Petersburg to utilize and exchange certain information about me in order to work together efficiently to coordinate these services and/or benefits.