Student Release Form (Page 2 of 2) in pdf

Student Release Form Page 2

PRIVACY ACT

In accordance with the Privacy Act of 1974 (Public Law No. 93-579, 5 U.S.C. 552a), you are hereby notified that the

Department of Labor is authorized to collect information to implement the Trade Adjustment Assistance Community

College and Career Training Program under 19 USC 2372 – 2372a. The principal purpose for collecting this

information is to administer the program, including tracking and evaluating participant progress. Providing this

information, including a social security number (SSN) is voluntary; failure to disclose a SSN will not result in the

denial of any right, benefit or privilege to which the participant is entitled. The information that is collected on this

form will be retained in the program files of the grantee and may be released to other Department officials in the

performance of their official duties.

The program was made possible by a $2,867,712 federal Trade Adjustment Assistance Community College and Career Training grant. Approximately 61% of funds were from federal

sources. WCC does not discriminate based on any characteristic protected by law in its programs and activities.

Student Release Form Page 2

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