ATTACHMENT - E
 
The University of the State of New York

THE STATE EDUCATION DEPARTMENT

GED Testing Office

P.O. Box 7348

Albany, New York   12224-0348

(518) 474-5906

 

VERIFICATION FORM FOR

NEW YORK STATE GED TEST APPLICANTS 17 OR 18 YEARS OF AGE WHO ARE CONFINED TO A FACILITY OR INSTITUTION OR ARE ADJUDICATED YOUTH

NOTE:  These are residents who are confined to a narcotics addiction control center, Office of Children and Family Services (OCFS) facility, jail or Department of Correctional Services (DOCS) facility or are patients in a hospital in New York State OR youth who are adjudicated under the direction of a prison, jail, detention center, parole or probation officer.

 

     Program Information                 PLEASE PRINT CLEARLY IN INK

Name of Facility/Institution/Agency

 

Test Center Code

 

 

 

Address  (Street/P.O. Box)             

                                                                                                        

 

 

 

City                                                                                                 

 

State                                                                                 

Zip Code

 

 

 

Applicant Information

 

Last Name

First Name

Middle Initial

 

 

 

Social Security Number                                      Age            

               

                              

 

             Date of Birth 

                                              

  Month      Day           Year

GED Practice Test Score (if applicable)

 

          

 

 

 

 

Official signature

By signing below, I verify that the above applicant is confined to the above named facility or institution, or is an adjudicated youth and has reached "maximum compulsory school attendance age."  Maximum compulsory school attendance age is reached when the school year in which the student turns 16, (or such older maximum age as the board of education of the school district may designate for required school attendance pursuant to section 3205(3) of Education Law) has ended (June 30).  I also verify that the high school equivalency diploma is an essential part of the rehabilitation process and the applicant demonstrates readiness to test.

 

 

 

            _________________________________________________________

                                 Signature of Facility/Institution Director                               

 

 

            _________________________________________________________

                                        Print or Type Director's Name

 

 

            _________________________________________________________

                                                           Date