Request for Access to the GED® Manager System

Instructions for Completion
GED Manager® access for the State of Illinois is restricted to adult education providers funded by the Illinois Community College Board (ICCB). Requests for access to the GED Manager® system must be completed and signed by the current Adult Education Program Administrator using this form. Please note: Each GED Manager® user must use a program-related (work) email address on GED Manager®. Email completed forms to hse@illinois.gov (preferred) or fax to 312-814-8993.

Requesting Adult Education Program Information
Name of Requesting Agency:
Street Address:
City:	State:	ZIP:
Adult Education Program Director’s Name:
Adult Education Program Director’s Title:
Adult Education Program Director’s Phone Number:
Adult Education Program Director’s Email Address:

I recommend that the following person(s) be given access to the GED® Manager System:
Name:
Title:
Phone Number:
Email Address:
Name:
Title:
Phone Number:
Email Address:
Name:
Title:
Phone Number:
Email Address:

Adult Education Administrator’s Approval
With my signature below I indicate that I understand and agree to the following: By granting access to this system, I am allowing the above-named person(s) to access confidential and sensitive, personally identifiable test-taker information. I accept full responsibility for ensuring that this information will be kept confidential and will not be used inappropriately by said person(s). I understand that I must inform the ICCB of any staff changes or terminations to ensure the security of this information.
Adult Education Program Director’s Signature	Date