HSE Testing Results

Southwestern Illinois College
Adult Education and Literacy Department
2500 Carlyle Avenue
Belleville, IL 62221

Consent form
Date of Birth*
Month
Day
Year
Please enter your name*
First Last
Give Consent to SWIC Adult Education and Literacy Department*
- I give my consent to Southwestern Illinois College Adult Education and Literacy Department to obtain the results of my HSE testing.
Rights and Privacy*
- I understand that all information obtained by SWIC will be maintained in accordance with the Family Educational Rights and Privacy Act (“Act”) and will only be used for the following purposes:
  - Information regarding the annual commencement ceremony;
  - Determining eligibility for available scholarships and notifying me of the same;
  - Tracking student progress through the High School Equivalency program; and
  - Responding to all mandated state reporting requirements.
Consent Acknowledgement*
- By submitting this form I acknowledge that SWIC may obtain my official HSE test results and give permission for all such results to be provided to Adult Education and Literacy Department.
CAPTCHA