Name of Person with Medical Difficulties
I acknowledge that the decisions of the Ratliff Foundation are final. I certify that the Applicant meets the basic eligibility requirements of the program and the information provided is complete and accurate to the best of my knowledge. Falsification of information may result in termination of any grant awarded. I permit/ do not permit the Ratliff Foundation to release my contact information to its affiliated organizations. I also authorize the Financial Aid office of my school to release to the Ratliff Foundation information on my financial aid status and I authorize the Texas Higher Education Coordinating Board to release information contained on any financial aid application filed with the same. All information submitted will remain confidential (except where permission to release contact information is authorized to affiliated organizations above).