NEDP LEARNER’S INTAKE and UPDATE MODEL FORM NEDP
Definitions, Policies, & Directions for Staff
DLLR-LWIS
Last Update: June 5, 2013
DLLR-LWIS MODEL FORM NEDP
NATIONAL EXTERNAL DIPLOMA PROGRAM (NEDP)
LEARNER’S INTAKE and UPDATE FORM
Definitions, Policies, and Directions for Staff
To provide an accurate profile for real-time data analysis, routinely provide to your MIS all learners’ entry and update information, and close records of learners as they exit the class or program throughout the fiscal year. Your report periods to the MIS must be at least quarterly in order to minimize incomplete reports and potentially false data that result from longer time periods between report cycles. Another reason for frequent reporting is that errors or problems may be identified and corrected on an ongoing basis.
Policy: Programs shall establish and follow procedures that will assure all learners’ data shall be submitted to the MIS that accurately reflects the learners’ entry and update status as of the last day of each quarter of the fiscal year until they exit the class or program.
Prior to submitting this form for data entry, staff must carefully review the information for errors and/or omissions. Question learners about any item where clarification is needed.
SPECIAL NOTE1. The order of the data elements presented here follows the order that appears on the LWIS Model Form NEDP: National External Diploma Program Learner’s Intake and Update Form.
2. Your program may have adapted Form NEDP so that the data elements appear in a different order or format.
3. Your program also may have eliminated some non-mandatory data elements.
4. Learners can complete all personal information with appropriate assistance from staff.
5. Instruct learners to neatly print the information requested with a pencil.
The National External Diploma Program Learner’s Intake and Update Form is used to collect basic information about a learner who is enrolled in the program. This includes demographics, goals, entry and update levels, contact hours, achievement, progress, and exit status.
LEARNER CAN COMPLETE THIS INFORMATION WITH STAFF ASSISTANCE
CODES FOR COUNTY, PROVIDER, TEACHER, AND CLASS
Ø County Code
Definition: The County Code is a unique identification number assigned to your program’s jurisdiction by the DLLR, regardless of the jurisdiction where the learner resides or where services are provided.
Policy: The County Code is required. Only DLLR is authorized to assign or change a County Code. Each County Code must be unique.
Directions: Enter the assigned 2-digit County Code. If you do not know your County Code, ask your program administrator for it.
Information: The County Code enables a program’s data to be organized and sorted in the LWIS database. To reduce errors, pre-enter the County Code on your NEDP Learner’s Enrollment/Update Form.
Ø Provider Code
Definition: The Provider Code is a unique identification number assigned to your program by DLLR, regardless of the jurisdiction where the learner resides or where services are provided.
Policy: The Provider Code is required. Only DLLR is authorized to assign or change a Provider Code. Each Provider Code must be unique.
Directions: Enter the assigned 4-digit Provider Code. If you do not know your Provider Code, ask your program administrator for it.
Information: The Provider Code enables a program’s data to be organized and sorted in the LWIS database.
Recommendation: To reduce errors, pre-enter the Provider Code on your NEDP Learner’s Enrollment/Update Form.
Ø Assessor Code
Definition: The Assessor Code is a unique identification number assigned to each assessor by local program administrators.
Policy: The Assessor Code is required. Only local program administrators are authorized to assign or change an Assessor Code. Each Assessor Code must be unique.
Directions: Enter your assigned 4-digit Assessor Code. If you do not know your Assessor Code, ask your program administrator for it.
Information: The Assessor Code enables a program’s data to be organized and sorted in the LWIS database.
Ø Advisor Code
Definition: The Advisor Code is a unique identification number assigned to each class by local program administrators.
Policy: The Advisor Code is required. Only local program administrators are authorized to assign or change an Advisor Code. Each Advisor Code must be unique.
Directions: Enter your assigned 4-digit Advisor Code. If you do not know your Advisor Code, ask your program administrator for it.
Information: The Advisor Code enables a program’s data to be organized and sorted in the LWIS database.
LEARNER SOCIAL SECURITY NUMBER OR ASSIGNED LWIS NUMBER
Definition: A SSN is assigned by the U.S. Government and is unique to each individual. An Assigned LWIS Number is created by your data entry person only if learner has no SSN.
Policy: Learner must report a valid and accurate SSN. All LWIS data is protected by federal and state laws.
Directions: Learner prints his/her 9-digit Social Security Number (SSN). If every effort has been made to obtain a SSN and none is available, print NO SSN in the SSN boxes. This will indicate to your data entry person that the learner has not forgotten to complete this area. Your data entry person will assign an LWIS Number for the learner, which subsequently should be provided to you to enter on the learner’s form.
Information: Every effort should be made to secure a SSN, even after the learner has been assigned a pseudo SSN. Using the correct SSN is the only way DLLR is able to share/match data to determine a learner’s achievement and progress for NRS Core Indicators 2 and 3. If learner achievement cannot be validated, your program’s DLLR funding may be reduced or eliminated.
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NEDP LEARNER’S INTAKE and UPDATE MODEL FORM NEDP
Definitions, Policies, & Directions for Staff
DLLR-LWIS
Last Update: June 5, 2013
PROGRAM ENROLLMENT DATE
Definition: This is the date of learner’s first contact/activity in the program–generally registration and orientation.
Policy: Learner must report a Program Enrollment Date from July 1 to June 30 of the current fiscal year unless a Continuing learner.
Directions: Learner prints Program Enrollment Date in the MM/DD/YY format. Check that learner has completed all boxes and has used zeros where necessary. Note: Continuing (Returning) learners should not enter a date, as LWIS will automatically display their enrollment date.
NAME: FIRST
Definition: This is learner’s first name as recorded on official documents such as Social Security card, birth certificate, driver’s license, etc.
Policy: Learner must report a First Name.
Directions: Learner prints legal First Name.
NAME: MIDDLE
Definition: This is learner’s middle name as recorded on official documents such as Social Security Card, birth certificate, driver’s license, etc.
Policy: Learner must report a Middle Name or initial, if available.
Directions: Learner prints legal Middle Name. If only an initial is available, learner enters the initial followed by a period. If no middle name, learner should print NONE in the middle name space.
NAME: LAST
Definition: This is learner’s last name as recorded on official documents such as SSN, birth certificate, driver’s license, etc.
Policy: Learner must report a Last Name.
Directions: Learner prints legal Last Name.
ADDRESS
Definition: This is learner’s complete, first-line mailing address which could include an apartment number, post office box number, or rural route delivery number.
Policy: Learner must report a complete, first-line mailing Address.
Directions: Learner prints complete street Address, including apartment or unit number, post office box number, or rural route delivery number where mail is received.
CITY
Definition: This is the city where learner receives mail and need not be learner’s city of residence.
Policy: Learner must report the City where mail is received. It may not be learner’s city of residence. It may be a city outside your program’s service area.
Directions: Learner prints City where mail is received.
STATE
Definition: This is the state where learner receives mail and may not necessarily be learner’s state of residence.
Policy: Learner must report the State where mail is received. It may be a state other than Maryland.
Directions: Learner prints State where mail is received.
ZIP CODE
Policy: Learner must report a 5-digit or 9-digit Zip Code.
Directions: Learner prints his/her 5-digit or 9-digit Zip Code.
HOME PHONE
Policy: Learner should report a Home Phone number if there is one. If learner has no home phone but has a cell phone or contact phone number, they should be reported.
Directions: Learner prints Home Phone number with area code (1st option), cell phone number with area code (2nd option) or contact phone number (3rd option). If learner has no phone, NONE should be printed in the Home Phone space.
WORK PHONE
Policy: Learner should report a Work Phone number if employed.
Directions: If employed, learner prints Work Phone number with area code.
DATE OF BIRTH
Policy: Learner must report a complete Date of Birth. Learner must be at least age 18 and officially withdrawn from school upon program entry.
Directions: Learner prints Date of Birth in the MM/DD/YY format. Check date for accuracy and verify that learner is at least 18 years old.
E-MAIL ADDRESS
Policy: Learner can choose to enter e-mail address.
Directions: Learner prints e-mail address.
MALE
Definition: This is what learner identifies as his gender.
Policy: Learner must report gender.
Directions: If applicable, learner checks the box by the word, Male.
FEMALE
Definition: This is what learner identifies as her gender.
Policy: Learner must report gender.
Directions: If applicable, learner checks the box by the word, Female.
CHILDREN
Definition: These are children within an age range of 0-21 who may or may not reside in learner’s household.
Policy: Learner should report the number of Children, if any, for each of the three age ranges.
Directions: Learner enters the number of Children, if any, for each of the three age ranges: 0-5, 6-13, and 14-21.
ETHNICITY/RACE
Definition: This is the ethnic/racial category to which learner self-identifies, appears to belong, or is regarded in the community as belonging.
Policy: (1) Learner must first indicate if of Hispanic or Latino ethnicity. (2) Learner must then indicate any racial category which applies.
Directions: (1) Learner selects either YES or NO for Hispanic or Latino. Learner circles the number in the box by any racial category which applies.
ETHNIC CATEGORY / DEFINITIONHispanic or Latino / A person of Mexican, Puerto Rican, Cuban, Central, or South American, or other Spanish culture or origin, regardless of race.
RACIAL CATEGORIES / DEFINITION
1 / American Indian/Alaska Native / A person having origins in any of the original peoples of North and South America (including Central America), and who maintains a tribal affiliation or community attachment.
2 / Asian / A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
3 / Black or African American / A person having origins in any of the Black racial groups of Africa.
4 / Native Hawaiian or
Other Pacific Islander / A person having origins in any of the original peoples of the Pacific Islands of Hawaii, Guam Samoa, or other Pacific Islands.
5 / White / A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
IF OTHER THAN USA, NATIVE COUNTRY
Definition: This is learner’s country of citizenship at birth if other than the USA.
Policy: This is completed only if learner is foreign-born and native language is other than English.
Directions: Learner prints name of Native Country in the space provided.
NATIVE LANGUAGE
Definition: This is learner’s primary/native language if other than English.
Policy: This is completed only if Primary/Native Language is other than English.
Directions: Learner prints the name of Primary/Native Language in the space provided.
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NEDP LEARNER’S INTAKE and UPDATE MODEL FORM NEDP
Definitions, Policies, & Directions for Staff
DLLR-LWIS
Last Update: June 5, 2013
HIGHEST DEGREE or LEVEL OF SCHOOLING COMPLETED
Definition: This is learner’s highest number of years of formal schooling completed or the credential or degree achieved.
Policy: Learner must report Highest Degree or Level of Schooling Completed in the U.S. or Other Country.
EMPLOYMENT STATUS
Definition: This is learner’s employment status at date of entry.
Policy: Learner must report Employment Status at date of entry.
Directions: Learner selects current Employment Status.
EMPLOYMENT STATUS / DEFINITIONEmployed-Full Time / (1) Works as a paid employee at one job 32 hours or more per week.
(2) Works at own business or farm.
(3) Works 15 hours or more per week as an unpaid worker at a family member’s business or farm.
(4) Not currently working but has job or business from which s/he is temporarily absent.
Employed-Multiple Jobs / Works as a paid employee at more than one job, regardless of hours per week.
Employed-Part Time / Works as a paid employee at one job less than 32 hours per week.
Not in Labor Force / Not employed and not seeking employment, e.g., stay-at-home caretaker, parent, student, incarcerated, disabled, retired.
Unemployed / Not working but is seeking employment. Is making specific effort to find a job and is available for work.
SIGNATURE & DATE
Definition: The signature is the learner’s signature and the date entered is the current date.
Policy: All learners must sign and date this form on the lines provided.
Directions: Learner signs name and enters current date.
Learner must be assisted with completion of the next two items, Entry Status and Goals.
ENTRY STATUS
Definition: These are characteristics which describe learner at entry.
Policy: Learner must report entry status. If none apply, select None. Learners participating in a funded Family Literacy Program must select the appropriate Family Literacy entry status.
Directions: Explain options to learner. Emphasize that the information provided is for statistical purposes only and will remain confidential. Learner selects all that apply. If none apply, direct learner to select None.
Information: Do not select any of the Family Literacy entry status items unless learner is participating in both the family and educational components of a funded Family Literacy Program.
ENTRY STATUS / DEFINITION /Community Corrections / Lives in a community-based rehabilitation center or in-home detention under the jurisdiction of the correctional system. This includes local detention centers/jails, work-release facilities, work farms, halfway houses, and those on parole and probation.
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