TFFC Tutoring Consent to Exchange Information Form

 

Tidewater Friends of Foster Care provides in-home tutoring for youth that are interested in improving their academic performance.

School Consent to Release of Information

Students participating in the TFFC Tutoring Program require a School Consent to Release student records on file with TFFC.

  • NOTE: The Consent for Information Exchange must be signed by the Parent or Legal Guardian.

  • TFFC Tutoring Program

    TFFC provides one-on-one tutoring instruction to youth. Enrolled students remain eligible for tutoring through the end of the academic year. Parents/Guardians are responsible for providing a consent to release grades information, a suitable work environment, as well as materials and supplies. Parents/Guardians may request a change of tutor if the relationship is not working for their student.

  • Student Information

  • CONSENT TO EXCHANGE INFORMATION ON STUDENT

    As the Parent/Legal Guardian, I understand that Tidewater Friends of Foster Care, Inc. (TFFC) provides services and benefits to my child. TFFC must have specific information to provide these services and benefits. By signing this form, I am allowing TFFC to exchange certain information so it will be easier for them to provide or coordinate these services or benefits. This consent will be provided to the school to allow exchange of information in support of tutoring services.
    This information will be exchanged ONLY for the purpose of Service Coordination for the TFFC Academic Tutoring Program.
  • I can withdraw this consent at any time by notifying Tidewater Friends of Foster Care. This will stop all Schools/Agencies from sharing information after they know my consent has been withdrawn. I have the right to know what information about has been shared, and why, when, and with whom it was shared. If I ask, Tidewater Friends of Foster Care will show me this information.
  • By selecting CONSENT box and Typing my Full Name above, I confirm my consent and understand that I am electronically signing this form.
  • This field is for validation purposes and should be left unchanged.