Referral Part B completed by Title II Adult Education Staff below Title I Submission. Click to enter information Title I Submission Information: Part A Submission IDLocal Adult Education AreaChoose an AreaAthens Technical CollegeCentral Georgia Technical CollegeChattahoochee Technical CollegeGeorgia Northwestern Technical CollegeLanier Technical CollegeNorth Georgia Technical CollegeOconee Fall Line Technical CollegeWest Georgia Technical CollegeTestParticipant Name First Last Participant Phone NumberParticipant Email Referring ProviderReferring Provider Email Participant's Vocational GoalReason for the Referral(Required) Participant needs Adult Education High School Equivalency HSE services: Participant does not have high school diploma or its equivalent – not currently enrolled K-12 system Participant needs Adult Ed training services {Additional Documentation:43}Adult Education Training Services Integrated Education and Training (IETs) English as a Second Language Classes Citizenship Classes Adult Literacy Classes Note: All individuals referred to Title II Adult Education program must be basic skills deficient (e.g., performing at or below 8.9 grade level, English Language Learner, or needing high school equivalency preparation services).Part B – To be completed by Title II Adult Education StaffTitle I and Adult Education Co-Enrolled(Required) Yes No If no, choose reason participant is not eligible for co-enrollment(Required) Participant did not meet Title II Adult Ed basic eligibility criteria* Participant did not follow through Other If Other, please describe.*Co-Enrollment Criteria Individual is 16 year old or older, not enrolled in K-12 system who: Is basic skills deficient (functioning at or below 8.9 grade level); or Does not have a secondary school diploma or its equivalent; or Is an English Language Learner Adult Education Staff Signature(Required)Date MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged.
