HSE-To-School GED Voucher Request Form

FEDERAL STATUTE ENTITLED: PRIVACY RIGHTS OF STUDENT

GED TESTING SERVICE may send a student's educational records to officials at the Workforce Development where the student participated in the Michigan HSE-To-School Program, upon the condition that the student will be notified of the transfer of information. The student must also receive a copy of the record if desired and have an opportunity to challenge the content of the record.

I understand and agree that my authorization will be signed electronically when I select the check box below. I also understand that my electronic signature means that I agree to participate in any GED Testing Service follow up surveys. I authorize GED Testing Service to provide the Workforce Development GED® Office staff my GEDTS survey responses, GED® test scores, and copies of my official GED® transcript.

Checking the box below also indicates that I grant permission for a GED Testing Service representative to contact me via e-mail with follow up surveys and that I will respond to those surveys in a reasonable amount of time.

*First Name

*Last Name

Middle Initial

*Birthdate

*Email from online GED account.

*Phone

*If you are enrolled in an Adult Education Program, you can have your voucher codes sent to your instructor. Would you like to have your voucher codes sent to your instructor? Yes No

*Provider or Program Email

*What is the program type? Adult Education Program Adult Education Correctional Program (Jail program)

Note: Vouchers will only be issued for test subjects that have received a "likely to pass" on the GED Ready Test. Upon scoring "Likely to Pass" on your GED Ready Practice test, you may apply for each test subject separately, by submitting this form each time, or you can apply to more than one test subject at a time. Vouchers will only be issued one time per content area. Use of HSE-To-School vouchers is dependent on the availability of funding provided by Michigan's 2021 P.A. 87.

Please allow 7-10 business days for voucher codes to be processed and sent to email(s) provided.

*Select your test subject Mathematical Reasoning Reasoning Through Language Arts Science Social Studies

*If you have scheduled a GED® test and fail to appear for that test, you will not receive a new voucher code for the subject missed. If you have a scheduling conflict you must request a new testing date 24 hours prior to your scheduled test time and date.

**Please print completed form and keep for your records before submitting.

*Today's Date

* I Authorize A check in the "I Authorize" box equates to a signed agreement to this Michigan Workforce Development authorization request by the person identified below. Completion and submission of this form is a requirement to be considered for any GED test vouchers provided by the HSE-To-School Program.

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HSE-To-School GED Voucher Request Form