Title II Adult Education to Title I Workforce Referral – Completed by Adult Education Partner Search for Your Local WorkForce Development FacilityLocal WorkSource Area(Required)Choose a WorkSource Area1 – Northwest2 – GA Mountains3 – City of Atlanta4 – Cobb5 – DeKalb6 – Fulton7 – Atlanta Regional8 – Three Rivers9 – Northeast GA10 – Macon – Bibb11 – Middle GA12 – Central Savannah River Area13 – East Central GA14 – Lower Chattahoochee15 – Middle Flint16 – Heart of GA17 – Southwest GA18 – Southern GA19 – CoastalTestAtlanta Regional(Required)Choose CountyFayetteGwinnettHenryRockdaleCherokeeClaytonDouglasParticipant Name(Required) First Last Participant Phone Number(Required)Participant Email(Required) Referring Provider(Required) Referring Provider Email(Required) Adult Education Services Start Date(Required) MM slash DD slash YYYY Adult Education Services End Date(Required) MM slash DD slash YYYY Participant Program Goal(Required) Reason for the Referral(Required) Participant Priority of Service Information(Required)Please check one or more of the boxes below: Participant is receiving Adult Ed HSE services with no high school diploma or its equivalent – not currently enrolled K-12 system Participant is receiving Adult Ed services due to TABE test results at or below 8.9 grade level Participant is receiving Adult Ed services due to being an English Language Learner Select AllAdult Education Staff Signature(Required)Date MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged. Find your WorkSource location click once to run the query Enter your Zip Code
