Directions: Please complete all fields below. Fields with an (*) must be completed.

A minimum age of 18 is required to be eligible for class enrollment.

CONSENT FORM

I, am enrolled in an adult basic education (ABE) program. This ABE program works with the following programs 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 (IDWD), Division of Adult Education and the Indiana *Department of Education.

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. 
• A representative from McDowell Education Center may call, email or text to follow up on employment, retained employment, and/or postsecondary education status.

By typing your name, you consent that this is your electronic signature and consent to the above information. 

Responsible Use Agreement

Purpose

BCSC teachers and students use technology and internet-based tools in their classrooms on a regular basis to support the learning environment and prepare students to engage in the rapidly changing world. These technologies improve student communication and collaboration skills, provide an authentic audience, and extend learning beyond the classroom walls while building digital citizenship skills. Student access to technology requires responsible, courteous, efficient, and legal use. It is important that students, adults, and parents recognize that the information posted on the internet is public, permanent, and needs to be appropriate.

BCSC Adult Education Technology - Students will use or have access to the following:

• Chromebook, Laptop computer, Desktop computer
• Open Wi-Fi (for use when a personal device is needed to access learning apps in the classroom)

Using Technology

• I will only use a device with permission and when appropriate.
• I will put the device away when instructed.
• I will keep the Adult Ed Wi-Fi password secure.

Digital Responsibility

• I will be a good cyber-cit
• I will be a good cyber-citizen by being honest, kind, and respectful when I communicate using my device.
• I will not take or post pictures or videos of someone without their permission.
• I will only share appropriate content with others.
• I will keep all personal information private.
• I will only personate myself when writing, recording, etc. while using technology.
• I will follow expectations and instructions when using technology.
• I will report and/or help prevent any bullying, abuse, or harm to others.
• I will follow all filters and security measures.
• I will keep my passwords private, except with my teacher (Family Educational Rights and Privacy Act or FERPA).
• I will follow copyright laws.

Technology Concerns

• When using technology, I will strive to be a responsible digital citizen. If I make a choice that is not in line with being a responsible digital citizen, I will work with a staff member to make it right.
• If something on the device breaks or does not work correctly, I will tell staff right away.

Device Care Guidance

• Return device to the storage location and resume charging
• Keep the device away from food or drinks
• Remove headphones carefully when you finish using them

I understand that using any school technology or network is a privilege I must earn through consistent responsible use identified in this agreement. I also understand that privileges may be removed or revoked for any length of time and that I may face additional consequences for irresponsible use.I have received, read, and agree to the above Responsible Use Agreement. In conjunction with BCSC School Board Policy 7540.

By typing your name below, you consent that this is your electronic signature and consent to the above information.