Release of Information

 

This form is valid for two years from participant's signature date

 

I authorize Holy Cross Family Learning Center  to exchange information relating to prior assessment(s) for training and emplyment including but not limited to: work history, vocational assessments, career planning, documentation related to eligibility, skills, training, quarterly wage data and Unemployment Compensation benefits with the agency(ies) listed on the left side of this form.

The Release of Information does not authorize the disclosure of any medical information or an other restricted third party information.

I understand theat this information may be used to determine eligibility for employment and training services, assist in the development of my individual training plan for education and employment, career planning, and/or may be used for statistical purposes.

I allow the NH Works System Partners listed on the left to release to each other the requested information when I am referred to partner services.  I understand the information will be used only on an as needed basis and will remain confidential, to the extent required and/or permitted by law.  This information cannot be shared with any other entity without my written permission.

A copy of this Release of Information is as valid as the original.  The Relesae is valid for both program and follow up services.

NH WORKS One-Stop Partner Agencies are Equal Opportunity Employer Ausiliary aids and services are available upon request to individuals with disabilities. TDD ACCESS: RELAY NH 1-800-735-2964

SYSTEM PARTNERS/PROGRAM SERVICES

NH EMPLOYMENT SECURITY -A free public Employment Service. which benefits the job seeker, the employer, and the economy by helping people find work through work search programs, employment information. and economic and labor market information https://www.nhes.nh.govl Employment Services Unemployment Insurance Benefits Trade Act Program Migrant and Seasonal Farmworker Program

DEPARTMENT OF HEALTH AND HUMAN SERVICES - https://www.dhbs.nh.gov/ TANF- Cash Assistance provides assistance to needy families with dependent children FOODSTAMPS - Supplemental Nutrition Assistance Program NHEP-Employment support program that provides cash assistance to eligible able-bodied parents and assists them in becoming self-sufficient.

NH DEPARTMENT OF EDUCATION-https:l/www.education.nh.gov:

ADULT EDUCATION-Provides a variety of educational opportunities to empower adults to become lifelong learners, to support individuals in identifying and achieving academic and/or career goals. VOCATIONAL REHABILIITATION- Assists eligible NH citizens with disabilities to secure competitive integrated employment and financial and personal independence by providing rehabilitation services. OFFICE OF WORKFORCE OPPORTUINTY Serves as the state administered entity for the Workforce Innovation and Opportunity Act. https://www.nhworks.org/ WIOA Youth Program - Provides academic and work based learning services to youth with the goal of self-sufficiency. WIOA Adult Program - Provides economically disadvantaged adults access to employment. education. training and support services to succeed in the labor market and obtain self-sufficiency. WIOA Dislocated Worker Program- Provides laid off workers access to employment. training and support services to succeed in labor market and obtain self-sufficiency. SCSEP-Community Service and Work-based training program for older workers. Provides job training and placement to those 55 or older.

COMMUNITY COLLEGE SYSTEM OF NH - The seven NH community colleges offer associates degree. certificate and skill based programs that provide opportunities for college education and career training. https://www.cesnh.edul

Work Ready NH-Tuition free workforce development program tailored to meet the needs of job seekers and career builders as well as provide training in the specific skills employers are seeking in their current and future employees. ApprenticeshipNII- Program supports the development of new registered apprenticeship programs and in healtheare. advanced manufacturing. hospitality and construction and infrastructure sectors. Registered apprenticeship is an employer driven model which combines on the job training and related classroom instruction to increase an apprentice's skill level and wages. http://www.FarnLearnNHorg

NH JOB CORPS- A tuition free training and education program that connects young adults to the skills and educational opportunities needed to establish a career. https://newhampshire.jobcorps.govs

OPERATION ABLE- Older Worker program that empowers older workers with job skills supports and training services to re-enter the workforce, https:lloperationable.net/staft