HIGH SCHOOL EQUIVALENCY (HSE) AGE WAIVER REQUEST …

GRETCHEN WHITMER

GOVERNOR

STATE OF MICHIGAN

DEPARTMENT OF LABOR AND ECONOMIC OPPORTUNITY

LANSING

JEFF DONOFRIO

DIRECTOR

HIGH SCHOOL EQUIVALENCY (HSE) AGE WAIVER REQUEST FORM Michigan Youth Challenge or Court Ordered Adjudicated Youth

I, __________________________________________________________________________

(Print: Student Name)

(Date of Birth)

(E-mail)

No Email

a) I am enrolled in an alternative high school/GED prep program.

b) I am at least 16 and less than 18 years of age.

c) I am authorizing the Data Recognition Corporation (TASC), or the Educational Testing

Service (HiSET), or the GED Testing Service (GED) to send test results to the school district attended.

I am a participant in the Michigan Youth Challenge Academy

I am an adjudicated youth and have been court ordered to complete High School Equivalency (HSE) testing to secure an HSE credential.

I am an adjudicated youth and I am unable to stay in regular school to complete a traditional K12 instructional program, it has been determined by the facilities instructor, counselor, probation officer, and/or court that it is in my best interest to obtain an HSE credential.

Signature of Student

Date

Test option: Choose One GED HISET ETS ID _____________ TASC

We, the undersigned as court appointed guardians through the State of Michigan or Jurisdictional County in which this individual youth resides, agree that it is in the best interest of this youth to obtain his/her HSE and attest this individual is at least 16 years and less than 18 years of age and is not currently enrolled in a "regular" K12 instructional program.

Signature of Program/Facility Representative

Printed Name of Program/Facility Representative

Phone Number

Date

Name of Facility or Program

Please return form to the State of Michigan HSE Office. Scan and email to: LEO-HSEProgram@

LEO is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities. WORKFORCE DEVELOPMENT, 201 N. WASHINGTON SQ., LANSING, MI 48913 ? workforce ? 517-335-5858

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