assistance. Upon registration, if permission is granted by the
registrant, the registrant's information shall be shared with
county directors of veterans affairs [and], other State agencies
and the State System of Higher Education.
* * *
(c) Duties of department.--The department shall provide
access to a paper and an online registry form which contain a
statement indicating the purpose for the registry. The forms
shall be developed to obtain the following information relating
to the veteran:
(1) Personal information, including title, first, middle
and last name.
(2) Age, gender, address and county of residence.
(3) Ten-digit phone number and e-mail address.
(4) Declaration of military service.
(5) Benefit and program information requests for various
benefits and programs for which veterans may be eligible.
(5.1) A statement as to whether the veteran is
interested in pursuing higher education, training programs or
professional development opportunities at institutions of
higher education within the State System of Higher Education.
The forms shall include a choice for the veteran to request
assistance with counseling and life changes through the
veteran's transition to a student of higher education.
(6) A signed statement, or, for online applicants, a box
that is checked, indicating that the veteran grants
permission for the department to store and share the
veteran's information with the county director of veterans
affairs for the county indicated [and with], other State
agencies and the State System of Higher Education to ensure
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