An Application Packet Page 14
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14Training Verification Form
(To be completed by School or Training Institution)
This form only needs to be completed if you are enrolled in a school or training program
.
Student Name:
Case #:
To: Administration Office of School
This is your authorization to release the information concerning my enrollment in training as required below. To establish
eligibility for child care assistance with Workforce Solutions Northeast Texas, verification of enrollment and/or attendance
is required. Please complete the appropriate section of this form as soon as possible. It is required before I can be
determined eligible for the program. Your cooperation and prompt return of this information is appreciated.
Signature of Student
Date
(TO BE COMPLETED BY SCHOOL OR TRAINING INSTITUTION)
Training Institution Name:
Address:
Semester Dates:
Training/Certificate Degree:
Estimated Completion Date:
COLLEGE
Number of Day Time Credit Hours
Number of Evening Credit Hours
Number of Online Hours
Are Online Hours on Degree Plan?
Yes
No
TECHNICAL SCHOOL
Schedule student has to attend
Is the student attending school regularly and working toward successful completion?
Yes
No
HIGH SCHOOL
Is the above student enrolled for the current semester?
Yes
No
What grade is the student current attending?
Is the student attending school regularly and working towards a successful completion?
Yes
No
GED
Schedule student has to attend
Is the student attending school regularly and working toward successful completion?
Yes
No
(MUST BE SIGNED BY SCHOOL OR TRAINING INSTITUTION STAFF)
Person Completing This Form (Please Print)
Title
Phone #
Signature
Date
Please return form to: Workforce Solutions Northeast Texas Child Care Services
1702 Hampton Rd, Texarkana, TX 75503
Phone: (903) 794-8999 Fax: (903) 794-8012
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