GED® test records can only be released when authorized by the GED® test taker. The personally identifiable information a test-taker provides to a GED® Testing Center and/or GED Testing Service/Pearson VUE when registering for the GED® tests cannot be made available to third parties without the test-taker’s permission. A GED® test taker’s personally identifiable information includes name, address, identification number, date of birth, test dates and test scores.

I, ______, in my capacity as GED® test taker, authorize GED Testing

Name

Service/Parchment and ______to share the following personal information: Name of Adult Education Preparation Site

What information about me will be shared: / Name, address, identification number, date of birth, test dates and test scores
Why I want my information shared (purpose) / For learning purposes including where to target instruction for GED test completion and GED® completion recognitions (e.g., graduation ceremonies)
Who I Want to have my information (Program) / Treasure Valley Community College
GED/ABE
(541)881-8822

I, the GED® test-taker, understand:

xThat I cannot be required to sign this release form. I am not required to share my information and that signing this release form is completely voluntary. If I would like to release information beyond the expiration of this release form, I will need to sign another written, time-limited release form.

xThe Program identified above may be required to release information in response to a subpoena or other order in a judicial or other governmental proceeding OR for GED Testing Service (GEDTS)/Pearson VUE in order to detect, investigate, or prevent fraud or other unlawful activity or violations of GEDTS/Pearson VUE testing policies.

This release expires on: ______Expiration should meet the needs of the

Date Timestudent and should not exceed the expected

end of the educational program.

I understand that this release is valid when I sign and date it, and that I may withdraw my consent to this release at any

time either orally or in writing.

Signed: ______Date: ______Time: ______

Parent or Guardian Signature if student is under age 18 is required.

Witnessed: _____Jan Bell______Date:______Time:______

Reaffirmation and Extension (if additional time is necessary to meet the purpose of this release)
I confirm that this release is still valid, and I would like to extend the release until ______
Date Time
Signed:______witness: ______
An extension cannot exceed 3 months in duration from the date of the initial release form. If additional time is needed, a new release form must be executed.

Effective November 17, 2016

Public Service Building • 255 Capitol Street NE • Salem, Oregon 97310

Phone (503) 947-5608 • Fax (503) 378-8434 •