Charting a Course: Responding to the Industry-Related
Adult Basic Education Needs of the Texas Workforce
Handbook One: Planning and Implementation Tips
for Program Planners and Administrators

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Module Four: Defining and Agreeing Upon Mutual, Achievable Goals and Objectives

Template for Replication: Statement of Confidentiality

This template can be transferred onto program letterhead, adapted, and presented to the employer as part of the letter of agreement for workplace education services.

 

 

 

The _________________Adult Education Program is committed to respecting the privacy of adult learners participating in its workplace education initiative. Signatures on this form indicate that all stakeholders with an interest in these services – company representatives, union representation, the adult education coordinator, and the instructor(s) – agree to the following provisions of confidentiality:

1. Individual employee educational assessment scores will be reported only to the individual employee. They will not be shared or discussed with anyone else without the employee’s permission.
2. Only aggregate assessment data will be shared with company personnel as needed to support recommendations for the configuration of classes, to report learner progress, and as part of the formative and summative evaluation of the program.
3. Individual assessment scores will not be shared with anyone outside the company, except with officials of the education agency providing the services, and then only for compilation of reports measuring overall program performance.
4. No assessment scores will be shared or discussed with anyone without the permission of the individual employee, the company manager, and the adult education program coordinator.
5. All assessment scores will be stored in a secure location, with access restricted to the instructor and the adult education program coordinator.

 

Signed:

 

___________________________________________________ Date ___________________
Company Manager or Representative

 

___________________________________________________ Date ___________________
Adult Education Program Coordinator

 

___________________________________________________ Date ___________________
Adult Education’s Workplace ESOL Instructor