Oklahoma State Department of Education 54 January 2011
RELEASE FORM FOR 16- AND 17-YEAR-OLD STUDENTS
For Adult Education Enrollment and/or General Educational Development (GED
®
)
Testing
Oklahoma State Department of Education
Lifelong Learning Section
1. Applicant’s Name: __________________________________________ Date: ______________________
2. Applicant’s Social Security Number: _______________________________
3. Applicant’s Date of Birth: ________________________________________
4. Last school attended (include school site, district and state): _____________________________________
5. In what month/year did you last attend school? ____________________
6. Last grade completed: ________________
Subscribed and sworn to before me this ___________ day of _________________________, _________________.
_______________________________________________
Notary Public Signature
My Commission expires the __________day of _________________, ___________.
To be completed by the parent/guardian:
I hereby affirm that I am the (circle one) Parent Guardian
of the above applicant, who is a legal resident of the_________________________________ School District;
and I agree that it is in his/her best interest to attend adult education classes and/or to take the GED Tests.
________________________________________
Signature of Parent/Guardian
To be completed by a school administrator:
The Administration of the ________________________________ School District is in concurrence with the
above statement and certifies that the above applicant is not currently enrolled in school.
___________________________________________
Signature of Principal or Superintendent
To be completed by the Chief Examiner or Adult Learning Center (ALC) Director:
I approve the above candidate for adult education classes and/or GED Testing.
_________________________________________ ______________________________________
Name of Chief Examiner or ALC Director Name of GED Candidate’s Testing Site
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