Bridges to the Future – Participant Rights and Consent Participant Name:* Participant ID:* County of Residence*CentreClintonColumbiaLycomingMifflinMontourNorthumberlandSnyderUnionOther 1. 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. Eligibility/Program Consent Picture and/or Quotes I consent to allow the PA CareerLink® and the Central Region WIOA/TANF Youth Development Program to use my picture and/or quote for slide or film/video tape purposes including the use of said pictures on television, on the internet, and in magazines and newspapers, wherever, whenever, and in whatever manner they shall desire, consistent with good taste which will not be derogatory, degrading, or detrimental to me in any way. I understand that I will not receive any compensation, neither now nor in the future, for the above. Transportation I consent to allow the PA CareerLink® to transport me (my child), when necessary and allowable, for employment or education related activities. CWDS Database I allow PA CareerLink® staff to enter information on my behalf into the CWDS website. Use of PA CareerLink® Resources I understand that computers in PA CareerLink® facilities are for job searching and training only. Failure to abide by this policy can result in suspension of computer and Career Resource Area privileges. 3. Consent to Release of Information As a participant in a WIOA/TANF Youth Development Program or the participant’s parent/guardian, 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 contractors of the Workforce Development Board, Central Pennsylvania Workforce Development Corporation. 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: Adult Basic Education Providers Advance Central PA Bureau of Workforce Development Administration Bureau of Workforce Partnership and Operations Central Susquehanna Intermediate Unit (CSIU) Central Susquehanna Opportunities, Inc. (CSO) County Assistance Offices Current and Former Employers Domestic Relations Offices Law Enforcement Agencies Local Education Agencies Office of Vocational Rehabilitation (OVR) PA CareerLink® PWE Worksite Social Security Information Tuscarora Intermediate Unit (TIU) Authorization includes the following additional organizations or individuals (Applicant must initial any additions): Additional Organization Initials Enter your initials here (required) Enter your initials here (required) Enter your initials here (required) Enter your initials here (required) Enter your initials here (required) Enter your initials here (required) All information will be maintained in the strictest of confidence. Participant Acknowledgement and ConsentBy signing I acknowledge that I received a copy, read and understand the documents explaining Participant Rights, I agree to and understand the Eligibility/Program Consent and 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*CentreClintonColumbiaLycomingMifflinMontourNorthumberlandSnyderUnionOther 1. 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. Eligibility/Program Consent Picture and/or Quotes I consent to allow the PA CareerLink® and the Central Region WIOA/TANF Youth Development Program to use my picture and/or quote for slide or film/video tape purposes including the use of said pictures on television, on the internet, and in magazines and newspapers, wherever, whenever, and in whatever manner they shall desire, consistent with good taste which will not be derogatory, degrading, or detrimental to me in any way. I understand that I will not receive any compensation, neither now nor in the future, for the above. Transportation I consent to allow the PA CareerLink® to transport me (my child), when necessary and allowable, for employment or education related activities. CWDS Database I allow PA CareerLink® staff to enter information on my behalf into the CWDS website. Use of PA CareerLink® Resources I understand that computers in PA CareerLink® facilities are for job searching and training only. Failure to abide by this policy can result in suspension of computer and Career Resource Area privileges. 3. Consent to Release of Information As a participant in a WIOA/TANF Youth Development Program or the participant’s parent/guardian, 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 contractors of the Workforce Development Board, Central Pennsylvania Workforce Development Corporation. 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: Adult Basic Education Providers Advance Central PA Bureau of Workforce Development Administration Bureau of Workforce Partnership and Operations Central Susquehanna Intermediate Unit (CSIU) Central Susquehanna Opportunities, Inc. (CSO) County Assistance Offices Current and Former Employers Domestic Relations Offices Law Enforcement Agencies Local Education Agencies Office of Vocational Rehabilitation (OVR) PA CareerLink® PWE Worksite Social Security Information Tuscarora Intermediate Unit (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 ConsentBy signing I acknowledge that I received a copy, read and understand the documents explaining Participant Rights, I agree to and understand the Eligibility/Program Consent and 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. Quicklinks Explore Careers Specialized Services Building Green Futures Build Skills Job Seeker Success Stories Additional Resources & Support Forms & Policies
