Central Connections – Rights and Consent

Participant Name:*
Participant ID:*
County of Residence*
1. Workforce Innovation and Opportunity Act (WIOA) Participant Rights

I hereby certify that I have received, read and understand the following documents as an Applicant/Participant of the Workforce Innovation and Opportunity Act (WIOA) and/or TANF Youth Development Program and acknowledge so with my signature at the end of this form.

Please also indicate your acknowledgement with a check next to each document received, read and understood.
*
- I have read and understand the Equal Opportunity is the Law-Civil Rights Statement Policy *
*
- I have read and understand the Advance Central PA EO Discrimination Complaint Policy and Procedures*
*
- I have read and understand the Advance Central PA Program Complaint Policy and Procedures*
2. Consent to Release of Information

As a participant in a Workforce Innovation and Opportunity Act Title I program or as a member of the participant’s family, I give permission to release any and all information pertinent to my past and present educational, employment, and training history to all partners of Central Region PA CareerLink® and all agencies subcontracted by Central Pennsylvania Workforce Development Corporation to provide Title I services. I authorize partners to exchange information concerning my situation during my enrollment and follow-up period. Partners and contractors may include, but are not limited to:
- Advance Central PA
- Bureau of Workforce Partnership and Operations
- Central Susquehanna Intermediate Unit (CSIU)
- Central Susquehanna Opportunities, Inc. (CSO)
- County Assistance Offices
- Current/Former Employers
- Domestic Relations Office
- Law Enforcement Agencies
- Local Education Agencies
- PA CareerLink®
- Social Security Information
- Tuscarora Intermediate Unit 11 (TIU)
Authorization includes the following additional organizations or individuals (Applicant must initial any additions):
Additional Organization
Initials
All information will be maintained in the strictest of confidence.

Participant Acknowledgement and Consent
By signing I acknowledge that I received a copy, read and understand the documents explaining WIOA Participant Rights, and I agree to and understand the Consent to Release Information.
Signature of WIOA Applicant*
Date*
MM slash DD slash YYYY
Auxiliary aids and services are available upon request to individuals with disabilities.
Equal Opportunity Employer/Programs.

Participant Name:*
Participant ID:*
County of Residence*
1. Workforce Innovation and Opportunity Act (WIOA) Participant Rights

I hereby certify that I have received, read and understand the following documents as an Applicant/Participant of the Workforce Innovation and Opportunity Act (WIOA) and/or TANF Youth Development Program and acknowledge so with my signature at the end of this form.

Please also indicate your acknowledgement with a check next to each document received, read and understood.
*
- I have read and understand the Equal Opportunity is the Law-Civil Rights Statement Policy *
*
- I have read and understand the Advance Central PA EO Discrimination Complaint Policy and Procedures*
*
- I have read and understand the Advance Central PA Program Complaint Policy and Procedures*
2. Consent to Release of Information

As a participant in a Workforce Innovation and Opportunity Act Title I program or as a member of the participant’s family, I give permission to release any and all information pertinent to my past and present educational, employment, and training history to all partners of Central Region PA CareerLink® and all agencies subcontracted by Central Pennsylvania Workforce Development Corporation to provide Title I services. I authorize partners to exchange information concerning my situation during my enrollment and follow-up period. Partners and contractors may include, but are not limited to:
- Advance Central PA
- Bureau of Workforce Partnership and Operations
- Central Susquehanna Intermediate Unit (CSIU)
- Central Susquehanna Opportunities, Inc. (CSO)
- County Assistance Offices
- Current/Former Employers
- Domestic Relations Office
- Law Enforcement Agencies
- Local Education Agencies
- PA CareerLink®
- Social Security Information
- Tuscarora Intermediate Unit 11 (TIU)
Authorization includes the following additional organizations or individuals (Applicant must initial any additions):
Additional Organization
Initials
Additional Organization
Initials
Additional Organization
Initials
Additional Organization
Initials
All information will be maintained in the strictest of confidence.

Participant Acknowledgement and Consent
By signing I acknowledge that I received a copy, read and understand the documents explaining WIOA Participant Rights, and I agree to and understand the Consent to Release Information.
Signature of WIOA Applicant*
Date*
MM slash DD slash YYYY
Auxiliary aids and services are available upon request to individuals with disabilities.
Equal Opportunity Employer/Programs.