Targeted Sector Initiatives (TSI): To Promote Career Ladder, Business Retention & Skills Upgrade Training For Employed Workers

1. Respondent Information

2. Proposed Training

Please provide the following information regarding the individuals and costs of the proposed training. Insert additional rows as needed.
Job Title of Individual(s) Receiving Training Number Receiving Training Avg. Rate of Pay Pre-Training - (Cannot exceed $26.00/hour before training) Est. Rate of Pay Post-Training - (Cannot fall below $12.00/hour before training) Training Provider Type of Training – Course Name Training Estimated Start Date Training Estimated End Date Certificate Issued/Recognized By: Certification Name: Classroom/ Training Hours Actual Cost of Training/Tuition per Individual

3. Participating Parties

Based on your organization’s structure, please complete either the Employer Respondents OR Public Institutions of Higher Learning & Entities that carry out programs under the National Apprenticeship Act section below.
Employer Respondents: For each educational institution proposed to provide training, list the following information:
Training Provider Name Contact Person Address Phone Email Address Institution Web Address The training provider will be Training will be delivered

Public Institutions of Higher Learning & Entities that carry out programs under the National Apprenticeship Act: List the following information for each employer you expect to participate:
Business Name Contact Person Address Phone Email Address Number of Employees Anticipated to Participate

4. Budget

5. Anticipated Outcomes

Please check the boxes that apply to the anticipated outcomes of the proposed project.
Will improve the long-term wage levels of trainees
Will create new jobs within our company
Will lower employee turnover in our company
Critical to the short-term viability of our company
Will assist in the training of veterans
Will assist in the training of the disabled
Will increase the profitability of our company
Will improve the short-term wage levels of trainees
Would help prevent company from having to relocate operations
Critical to the long-term viability of our company
Will make this location more competitive within company
Will assist in the training of minorities
Will assist welfare to work participants
Important to the stated mission of our company
Will be an important component of our company’s overall workforce employee development efforts
Will assist in the improvement of international trade opportunities

6. Certification by Authorized Company/Institution Representative

As an authorized representative of the company/institution listed above, I hereby certify that the information listed above and attached to this application is true and accurate. I am aware that any false information or intended omissions may subject me to civil or criminal penalties for filing of false public records and/or forfeiture of any training award approved through this program.

Typing in your name serves as your electronic signature.

Name and Electronic Signature:
Email Address:
Today's Date:

7. File Uploads

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