IWT Application & Project Budget - OCIC

BUSINESS INFORMATION

EMPLOYER NAME *

MAILING ADDRESS *

Address Line 1

Address Line 2

City

State

Zip Code

AUTHORIZED BUSINESS REPRESENTATIVE *

First

Last

TITLE *

PHONE *

EMAIL *

DATE OF INCEPTION OF BUSINESS *

YEARS IN BUSINESS AT PRESENT LOCATION *

TOTAL NUMBER OF CURRENT FULL-TIME EMPLOYEES (UNDER THE FEIN#) *

LEGAL STRUCTURE OF BUSINESS *

SOLE PROPRIETORSHIP
PARTNERSHIP
CORPORATION

LIST THE DESIGNATION OF YOUR CORPORATION *

FEDERAL ID# *

UNEMPLOYMENT COMP ID# *

BRIEF COMPANY DESCRIPTION (PLEASE INCLUDE SERVICES AND/OR PRODUCTS) *

IS YOUR BUSINESS CURRENT ON COUNTY TAX OBLIGATIONS? *

IS YOUR BUSINESS CURRENT ON CITY OR LOCAL TAX OBLIGATIONS? *

IS YOUR BUSINESS CURRENT ON STATE TAX OBLIGATIONS? *

IS YOUR BUSINESS CURRENT ON FEDERAL TAX OBLIGATIONS? *

ESTIMATED TOTAL AMOUNT SPENT ON TRAINING ANNUALLY *

IS YOUR COMPANY RECEIVING / APPLYING FOR ANY OTHER PUBLIC TRAINING FUND? *

IF YES, PLEASE EXPLAIN *

HAS YOUR COMPANY HAD AN IWT AGREEMENT IN THE PAST OR WITH A DIFFERENT AGENCY? *

IF YES, BREIFLY DESCRIBE OUTCOME/STATUS *

IF YOUR BUSINESS IS MINORITY OWNED, PLEASE CHECK ALL APPLICABLE

Women-owned
Asian-American owned
African-American owned
Native-American owned
Hispanic/American owned
Other minority owned

PLEASE SPECIFY *

TRAINING INFORMATION

DOES YOUR BUSINESS USE ONE-STOP SERVICES? *

IF YES, CHECK APPLICABLE

list job openings
job fairs
testing & assessment
mass hires
other

IF NO, PLEASE EXPLAIN *

DO YOU AGREE TO LIST ALL FUTURE OPENINGS WITH THE ONE-STOP? *

IF NO, PLEASE EXPLAIN *

DESCRIBE DESIRED TRAINING *

START DATE *

END DATE *

TOTAL AMOUNT REQUESTED *

NUMBER OF TRAINEES *

TRAINING PROVIDER *

Training Organization
Training Delivered

YOU SELECTED 'TRAINING ORGANIZATION' *

Public
Private
Employee Trainer

YOU SELECTED 'TRAINING DELIVERED' *

On-site
Training institution
Remote site

IF REMORE SITE, PLEASE LIST LOCATION *

Location Name and Address

NAME OF TRAINING PROVIDER *

TRAINING PROVIDER ADDRESS

Address Line 1

Address Line 2

City

State

Zip Code

AUTHORIZED TRAINING PROVIDER REPRESENTATIVE *

TITLE *

TRAINING PROVIDER PHONE *

TRAINING PROVIDER EMAIL *

TRAINING PROGRAM FOCUS *

Layoff aversion (mandatory)
Upgrade employee skills
Increase skills/wages
Portable skills
Retention
Other

IF OTHER, PLEASE SPECIFY *

ANTICIPATED OUTCOMES *

Layoff aversion/save jobs within the business
Create new jobs
Training disabled workers
Increase trainee wage
Training for welfare-to-work
Enhance viability
Training veterans
Prevent relocation
Lower turnover
Training minorities
Increase profitability

ESTIMATED # OF JOBS SAVED *

ESTIMATED # OF NEW JOBS *

ESTIMATED % OF WAGE INCREASE *

BRIEFLY DESCRIBE HOW THE TRAINING WILL ACHIEVE THE ANTICIPATED OUTCOMES AND CONTRIBUTE TO THE PURPOSE OF INCUMBENT WORKER TRAINING *

You may refer to the IWT Guide for this section.

HOW DID YOU LEARN ABOUT THE INCUMBENT WORKER TRAINING PROGRAM? *

IWT PROJECT BUDGET

Please show all formulas used to calculate totals, as indicated. Note: Training funds cannot be used to reimburse any training costs occurring before the application is approved and no partial reimbursements will be made prior to the completion of the total project. You may include other items for consideration as required, such as the IWT Trainee Log.

Reimbursement will only occur after the training, once GOWBI or its sub-grantee receives verification of training completion, paid invoices, and costs associated with the employer contribution.

Download the IWT Project Budget listed above. After you complete the budget, please upload the IWT Project Budget here: *

Click or drag a file to this area to upload.

Once you submit..

You will receive a copy of IWT Application & Project Budget via the email your provided at the beginning of the application (please check your spam/junk mail).

After you hit submit, you will be redirected back to the IWT Section of the Training Assistance webpage. From there, complete the IWT Contract Agreement under Step 3.

Thank you.