Information Release

INFORMATION RELEASE

I certify that the information in the application form is true and accurate. I understand that misrepresentation of any material fact may be grounds for ineligibility for program resources and related services. 

I acknowledge that information provided in my application may be subject to disclosure, if requested, pursuant to the Access to Public Records Act. 

I grant permission to Purdue Manufacturing Extension Partnership (MEP) and the City of South Bend to receive and store the data collected in the application form and from future surveys sent by Purdue Manufacturing Extension Partnership (MEP) if I become a participant. I authorize Purdue Manufacturing Extension Partnership (MEP) and the City of South Bend to collect the following for the purpose of collecting and compiling data to assess and report on the effectiveness of Purdue Manufacturing Extension Partnership (MEP) generally: 

• Residency information 
• Employment status and post-program job placement 
• Salary information 
• Work satisfaction survey answers 
• Training and academic information including but not limited to practice exam results, homework grades, and remarks from instructors related to preparation for the certification exam 
• Certification or certificate exam grades and retake information 

I acknowledge that the involvement of City of South Bend, by and through Purdue Manufacturing Extension Partnership (MEP) and its Partner Organizations, is limited to providing financial assistance towards training and certification costs, as more fully described in an award issued pursuant to this Program. I acknowledge that I am solely responsible for enrolling in any training or certification program and the completion of the requirements.  

I acknowledge that my participation in this Program does not guarantee employment with the City of South Bend, its Partner Organizations, or any other entity. 

I assume all liability associated with the use of technological equipment and services. I also release the City of South Bend, Purdue Manufacturing Extension Partnership (MEP) and its Partner Organizations from all liability, including any claim for indemnification or contribution. Purdue Manufacturing Extension Partnership (MEP) shall not be liable under this agreement for any economic or personal damages, including loss of income, profits or revenues, business interruptions, and loss of information or data related to my involvement in this program. 

I agree that I may be photographed, recorded, and videotaped by the City of South Bend, Purdue Manufacturing Extension Partnership (MEP), its Partner Organizations, or any media without receiving compensation of any kind. I grant the City of South Bend, Purdue Manufacturing Extension Partnership (MEP) and its Partner Organizations the right to edit, use, and reuse this footage as deemed appropriate for future productions and publications, which may be viewed by public and private sector audiences. I also hereby release the City of South Bend, Purdue Manufacturing Extension Partnership (MEP) and its Partner Organizations from all claims, demands, and liabilities whatsoever in connection with the above. 

Contact

Any questions regarding the trainings or registration process should be directed to Jacob Alexander at jalexand@southbendin.gov or (574) 235-9278.