The information provided is complete and correct to the best of my knowledge. I agree to abide by AES Literacy Institute policies, rules and regulations. I further understand the submission of false information is grounds for rejection of my application, withdrawal of acceptance, and cancellation of enrollment. My signature below shall constitute acknowledgement to statistical use of my records of enrollment, progress, and transition under the application laws, state regulations and AES Literacy Institute internal policies as aggregate statistical data in evaluation of the program, and shall constitute a precondition for enrollment in this adult education and literacy program. I acknowledge that the AES Literacy Institute will release information to other state and federal agencies for verification, follow-up, and tracking and to generate reports to monitor the program. I give my consent for release of directory information, photo/video, which consists of name, address, telephone number, date of birth, dates of attendance, degrees obtained, and field of study. Participants who are 17 years of age must have written permission to participate in the program.