Request for Access to the PSI (HiSET) Client Portal

Instructions for Completion
PSI Client Portal 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 PSI Client Portal must be completed and signed by the current Adult Education Program Administrator using this form. Please note: Each PSI Client Portal user must use a program-related (work) email address on the client portal. 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 PSI Client Portal:
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 portal, 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