Global - COMPETE/RISE Inquiry Form

PERSONAL INFO

First Name

Preferred First Name (Optional)

Middle Name

Last Name

Suffix (Optional)

Birthdate

CONTACT INFO

Email Address

Email Address Confirmation

Home Phone Number

Cell Phone Number

Would you like to receive text messages from The University of Memphis?

Yes

No

EMPLOYER INFORMATION

What type of City of Memphis Employee are you?

First Responder

All other City of Memphis divisions

Current Certifications

Paramedic

EMT

Firefighter

Other

EDUCATION & INTERESTS

Highest Level of Education

Will you be pursuing an undergraduate or graduate level program?

Primary Academic Interest:

Program of Interest

Student Consent

I authorize my employer to release my training record to the University of Memphis.

Yes

To receive tuition assistance through this program we must share your educational records (including financial aid, grades, academic progress, etc) with your employer. The privacy of your educational records is normally protected under the Federal Educational Rights and Privacy Act (FERPA). Please review the FERPA guidelines and respond to the statement below. *

Family Educational Rights and Privacy Act (FERPA) website

I approve the release of my educational information to my employer and any third party directly related to my tuition benefits. I understand that this information is normally protected under FERPA guidelines, however I give my consent to share this information for the purpose of this program’s direct billing process. I also understand that if I do not give my consent, I will not be able to receive tuition assistance in this program.

Yes

No