Release of Information Form
I, [Student's Name], am enrolled in Charlestown Adult Education, an Adult Education (AE) program. The state of Massachusetts pays for this program. This AE program works with other programs to help students improve their skills, get better jobs, and enroll in college or training. The programs work together to make it easier for students to use their services. The state needs to know if the programs are helping students achieve their goals.
The information that I provide to this program will be matched against the employment records, GED and HiSET test results, and college and training enrollment so the state can evaluate and improve AE programs and to report results to the federal and state governments. Researchers may use this information to evaluate and improve AE programs. My records will be kept strictly confidential.
Other programs and agencies that the state Department of Elementary and Secondary Education works with are listed below:
•Other adult education programs paid for by the Massachusetts Department of Elementary and Secondary Education
•ETS, HiSET and Pearson GED
•National Student Clearinghouse, public and private colleges
•State executive offices, departments, and agencies including, but not limited to, the Executive Office of Labor and Workforce Development, Department of Unemployment Assistance, Department of Revenue, and Department of Transitional Assistance, MassHire Career Centers and job training programs
With my permission, the AE program that I am enrolling in may use my employment records to evaluate and improve their services. By digitally signing this form, I give permission to the Massachusetts Department of Elementary and Secondary Education to share my data with this AE program.
*Students under the age of 18 must have this consent form signed by the student’s parent or guardian.
(Physical copy of this document must be signed upon arrival to Charlestown Adult Educations physical location. This is a temporary digital copy due to the COVID-19 pandemic school closings.)