Texas Education Agency

Continuing Education and School Improvement

GED Test Administration Withdrawal Form

For 17 Year Olds

This withdrawal form must be completed for seventeen (17) year olds who are seeking to take the General Educational Development (GED) test and are not enrolled in an approved High School Equivalency Program (HSEP).

Please Print

Student Information:

Last Name First Name Middle Name Maiden Name

_______-_______-______ ________/________/________ _____________

Social Security Number (Month/Day/Yr) Age

Date of Birth

________/________/_______

(Month/Day/Yr)

Date Withdrawn from School

Has this student been enrolled in an approved HSEP for any length of time after January 1, 2002?

Yes * No

*If an individual has been enrolled in an approved HSEP after January 1, 2002, but is not currently enrolled in an HSEP, then the individual may not test prior to his/her 18^th birthday, unless the student has taken all required assessment instrument at another school.

School Information:

__________________________ _________________________ ___________________

School Campus Name School District Name County-District #

_________________________________________ _________________________________________

Campus Principal or Designee Signature of Principal or Designee

_________________________

Date of Signature

PARENT / GUARDIAN CONSENT

TO TAKE THE TESTS OF

GENERAL EDUCATION DEVELOPMENT (GED)

(To be completed by parent/guardian of 17-year-old applicant)

My son/daughter, ____________________________________, is not enrolled in school and has my permission to take the General Educational Development (GED) Tests. If passing scores are obtained on the tests, I understand that a Texas Certificate of High School Equivalency will be issued.

Name of School My Son/Daughter Last Attended

I, _______________________________________, authorize the GED Chief Examiner to verify

^{(Parent’s name)}

with the above named school, or any other school that my son/daughter has attended, the current enrollment status of my child. I authorize any school attended by my son/daughter to release to the GED Chief Examiner any information necessary to confirm current enrollment status, including information other wise made confidential under the Family Education Rights and Privacy Act, 20 U.S.C. Section 1232g.

I understand that if the information provided on this form is found to be incorrect, the testing center GED Chief Examiner can refuse to administer or score the GED tests and the state can refuse to issue a score report or high school equivalency certificate based on your son’s/daughter’s tests results.

______________________________________________ ___________________

Parent / Guardian Signature Date