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Career & Technical Education Student Information Release Form
Career & Technical Education Student Information Release Form
This form allows Pathways to report to the Indiana Department of Education.
Student Name
*
First
Last
Home School
Columbia City
Fairfield
Goshen
Wawasee
West Noble
Statement Agreement
I AGREE to release information regarding my enrollment (emancipated student) or my student’s enrollment in a career or technical education course to potential employers that contact the school to recruit students with particular career and technical skills. The school shall also provide enrollment information to the Department of Workforce Development (DWD) through the InTERS reporting system. The DWD may provide the enrollment information to potential employers that contact the DWD to recruit students with particular career and technical education skills.
Agree
Statement Refuse
I REFUSE to release information regarding my enrollment (emancipated student) or my student’s enrollment in a career or technical education course to potential employers that contact the school to recruit students with particular career and technical skills.
Refuse
I understand the information may be released orally or in the form of copies of written enrollment information, when preferred by the requester. I have a right to inspect any written information released pursuant to this Consent. I understand I may revoke this Consent upon providing written notice to the Department of Workforce Development by emailing CTEReleaseForm@dwd.IN.gov. I further understand that until this revocation is made, this consent shall remain in effect and my enrollment information will continue to be provided as detailed in this Consent.
*
Agree
Disagree
Signature
Date
MM slash DD slash YYYY
Email
Δ
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