NEW YORK STATE EDUCATION DEPARTMENT Adult Education and Workforce Development Team Program Information Form Directions 1. Please complete this report and return to Tom Orsini, NYSED, Education Bldg., 89 Washington Avenue, Room 307 EB, Albany, NY 12234 2. Report class information about State Education Dep’t funded classes only. 3. Please keep this office informed of any changes by submitting a revised report.					Agency Name
					Contact Person
					Telephone Number (Include Area code) ( )
Teacher’s Name	Class	Dates Classes Begin and End	LOCATION	CLASS INFORMATION
			Site Name and Address	Course Title		Meeting Days	Hours Start/End	Number of Students
	1
	2
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	12

NEW YORK STATE EDUCATION DEPARTMENT Adult Education and Workforce Development Team Program Information Form Directions 1. Please complete this report and return to Tom Orsini, NYSED, Education Bldg., 89 Washington Avenue, Room 307 EB, Albany, NY 12234 2. Report class information about State Education Dep’t funded classes only. 3. Please keep this office informed of any changes by submitting a revised report.					Agency Name
					Contact Person
					Telephone Number (Include Area code) ( )
Teacher’s Name	Class	Dates Classes Begin and End	LOCATION	CLASS INFORMATION
			Site Name and Address	Course Title		Meeting Days	Hours Start/End	Number of Students
	13
	14
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	16
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	24