PROSTEP EMPLOYEE TRAINING ASSISTANCE FUND Application & Training Plan The ProSTEP Employee Training Assistance Fund is a project funded through Worksystems, Inc. by the US Department of Labor and managed by WorkSource Portland Metro to provide training for employed workers in certain H-1B Visa occupation groups in the Advanced Manufacturing and IT/Software industries. The grant will pay up to $400 per employee for training that provides a recognized credential. There is a dollar for dollar matching funds requirement. Company Name Contact Person for Application Phone Number E-mail Address Street Address Mailing Address (if different from Street Address) Minority and Women Owned Emerging Small Business (MWESB) A portion of grant funds are reserved for MWESB certified businesses. For information on certification click here Is your business certified in the State of Oregon as a MWESB? Yes No National Career Readiness Certificate (NCRC) Does your business “prefer” job candidates who have the NCRC when hiring? Yes Would you like more information on the NCRC and how businesses use it? Yes No No Product/Service Description Provide a brief description of the nature of your business and the products or services you provide. Industry Classification Advanced Manufacturing IT/Software Employees for Training Number of non-duplicated workers to receive training: All employees targeted for training have, at minimum, a High School Diploma or equivalent. Yes Occupation Groups represented in total: Engineering Technicians Industrial Production Managers Computer Support & All Other Specialists Computer Hardware Engineers Machine Setters, Operators & Tenders Welding, Soldering & Brazing Workers Inspectors, Testers, Sorters, Samplers & Weighers Engineers Logisticians Millwrights Sales Managers Machinists Tool & Die Makers No Computer Software Engineers, Systems Software Computer Software Engineers, Applications General & Operations Managers Network & Computer Systems Administrators Systems Administrators/Architects CNC Machine Tool Operators CNC Machine Tool Programmers Structural Metal Fabricators/Fitters This program is financed with funds provided through Worksystems, Inc., from the U.S. Department of Labor. Worksystems/WorkSource is an equal opportunity employer/program. Auxiliary aids and services available upon request to individuals with disabilities. To place a free relay call in Oregon dial 711. PROSTEP EMPLOYEE TRAINING ASSISTANCE FUND Application & Training Plan Proposed Training Describe the proposed training. Include a description of the training goals, timeline for completion, and how training will contribute to the career advancement of the targeted employees. If approved, this description with the additional information provided on this page will become the Training Plan referenced in all contract documents. Training Name: Training Start Date: Training End Date: Description: Please indicate the type of credential that will be awarded as a result of the proposed training: AA/AS Degree BA/BS Degree Occupational Skill Certification Professional License Industry Recognized Certificate Attributes of industry-recognized certificates for incumbent workers could include: Accepted by employers throughout the industry as representative of skills and attributes necessary in the position/occupation category Portable within or across industries Certificates issued by an employer that increases or upgrades the skills of the training participants and leads to one or more of the following: lay off aversion, job retention, skill increase, wage increase, and/or job promotion Proposed Training Costs Detail the total training costs and how the dollar for dollar match requirement will be met. Line 1 Total Training Costs $ Line 2 Training Costs supported by the grant (up to $400 per trainee) $ Line 3 Match from company-paid training costs (subtract Line 2 from Line 1) $ Line 4 Match from wages paid to workers while in training $ Line 5 Total Match for project (add Line 3 and Line 4) $ Page 2 REV 2015-05-06 PROSTEP EMPLOYEE TRAINING ASSISTANCE FUND Application & Training Plan Participant Registration and Tracking Compliance The US Department of Labor requires that information be reported about trainees receiving benefit from the project. WorkSource staff will assist sponsors of successful projects with access to the online registration process, however workers receiving training will be required to provide a minimum level of personal information that is provided back to the funder in aggregate to report on the success of the program. For grant eligibility purposes, workers will also need to provide a copy of a government issued photo identification to verify their identity and date of birth. Companies will need to report the following information on workers trained by the grant: Employment retention data, for each worker trained, for two quarters following the completion of training Occupational data for workers trained (i.e., occupation title, employment start date, promotions or advancements after training, wage and wage gains) An attestation that wages were paid to employees while in training if using this to meet the match requirement By signing this application your company agrees to comply with the grant’s registration, matching funds, training and employment reporting requirements. I hereby declare that the information provided herein is accurate, valid and a full disclosure of requested information. I am fully authorized to represent the company listed above, to act on its behalf, and to legally bind it in all matters related to this application. Name Title Signature Date (The remainder of this page is blank) Page 3 REV 2015-05-06