am enrolled in an adult basic education program. This program works with the following organizations and agencies to help students improve their skills and earn better jobs: 

• Other state-funded adult education programs
• WorkOne offices and job training programs
• Public and private colleges
• State executive offices, departments, and agencies including the Indiana Department of Workforce Development (DWD), Division of Adult Education and the Indiana Department of Education
• The organization affiliated with your classroom (including community centers, libraries, faith organizations, school districts, etc.)

By signing this form, I understand and agree to the following:

• DWD use of directory information (name, address, birth, and social security number) to match test score records, wage information, and college/training program enrollment records that assist the state to evaluate and improve its programs and to report results to the federal and state government.

• The sharing of information between the agencies and programs listed above. This information may include my name, enrollment information, education/career goals, test scores, and employment history. The information will be kept strictly confidential and will be used for program administration, research, and evaluation purposes.

*Students under the age of 18 must have this consent form signed by the student’s parent or guardian.

As a career training student:

• I understand attendance in our certification classes is very important. I agree to attend all scheduled class sessions for my career training class, arrive on time, and stay until the end.

• I agree to communicate with my instructor, so they are aware of any attendance matters.  I will communicate this in a timely manner via email and/or phone per teacher’s instructions given to me.

• I agree and understand that I must take the certification exam at the end of the career training class. If I do not attempt to take the certification exam, I understand that I may be liable for up to 50% of the course tuition.

• If you have children, I understand that for safety reasons, NO children are (under anycircumstances) allowed to attend any classes, clinicals, testing, or labs.

• I understand that I must complete ALLenrollment steps required by MSDWT adult education, to begin my career training class.

I understand all of the above information and agree to fulfill my obligations as a career training student.

I understand that if I do not fulfill the above obligations, I will be dismissed from the program and all books/materials must be returned to Washington Township Adult Ed. I understand that I will not be eligible for any more training opportunities through Washington Township Adult Ed.