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Buffalo Public Schools Adult Education Division
Vocational Registration Form
   (* Denotes Required Field)
Employment Status
Race/Ethnic Identity (Select all that apply)
Barriers to Learning/Employment. Must select at least one. (Select all that apply)
Are you a parent or guardian of a child/children under 21?
Are you a single parent?

If you answered 'yes' to either question above, enter the number of school age chldren at each level on the right >>>>>

Do you have a quiet place at home to study? Is it available...
Are you someone who...
When you think about all the things you do in a typical week, do you have 6 hours per week to commit to a distance learning proram?
In your life, is there a lot of routine?
Do you have access to internet at home?
If you prefer 'Online Distance Learning' are you comfortable using the Internet?
When given instructions fo an assignment do you prefer to...
Do you think your reading skills are...
Do you think your writing skills are...
Do you think face-to-face interaction with a teacher and other students is..

Release of Information: By participating in this state and/or federally funded adult education and/or family literacy program, I agree to the release of the information contained in my program records, including, but not limited to, social security number, assessment results and attendance, to the New York State Department of Education (NYSED). Required information for learner participation is indicated with an asterisk (*). This information may include follow-up with employment data and other educational records and will be used in aggregated or non-personally identifiable form, for reporting as required by state and federal laws. This information may also be used for research and analysis purposes during this year and/or subsequent years, Information provided will remain secure. Unless otherwise noted, only NYSED, its authorized contractors or the local program will have exclusive access to this information.

DIstance Learning Agreement: I accept the invitation to Home Study, and I agree to the following:1. I will work a minimum of six (6) hours per week in the Home Study program and record the time each week on my Work Time Record sheet. Or on line program automatically records time2. I will complete all work assigned to me. I understand that is it necessary to work in each of the following areas to be best prepared to test for the HSE: reading, math, English, reading in the content fields of social studies and science, and English composition. 3. I will return some finished work on each assigned date. 4. I will contact my instructor as soon as possible if there are important changes that may affect my program such as moving, illness, new telephone number, etc. 6. I will take the HSEexam when recommended by my instructor at the most available time and location.

Your submission was successful!

A career advisor will contact you in the next few days to request your Social Security Number. Thank you.

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