State Youth Employment and Training Program 2009 – 2010
Program Requirements
Participant Eligibility:
Age:
14 to 21 years (defined as individuals born between 7/1/88 and 7/1/95); under 16 requires
parental consent at the time of initial enrollment.
Income:
Any youth to be served in the year-round program must have family income less than 185% of
the federal poverty income level relative to family size (members of families that receive SNAP
(formerly known as Food Stamps), cash payments under the Temporary Assistance for Needy
Families, and cash payments or medical assistance under the State Administered General
Assistance programs are categorically income-eligible), or eligibility for or participation in
reduced or fully subsidized school meal programs.
Residency:
Local Boards may set criteria for residency.
Year-Round Youth Employment and Training Requirements:
Period:
Wages:
Worksites:
Employment and training program of participants in the year-round component may occur
between October 1, 2009 and June 30, 2010.
Youth participating in a paid work experience must be paid at least the state minimum wage.
Public or not-for-profit entities, and private for profit; working conditions must comply with
applicable health and safety laws, laws governing employment of minors.
Funding:
Use of Funds: a) a maximum of 5% of the total contract amount may be used for indirect costs related to project
administration; and b) a maximum of 25% of the total contract amount may be used for supportive services.
Administrative Requirements
Grant Recipient:
Workforce Investment Boards.
Contract Agreement: Submit one original and two copies of the complete package by November 27, 2009 to:
Connecticut Department of Labor
WIA Administration
Attention: Michelle LaRose
200 Folly Brook Boulevard
Wethersfield, CT 06109
Uniform
Application:
DOL provided Participant Application form.
Plan of Service:
Due November 27, 2009; DOL provided form.
Project Reporting:
Boards will be required to provide quarterly programmatic and financial reports due
January 20th, April 20t and July 20th . The final reports, including Participant
Demographic Report, and close-out package are due August 15, 2010.
Collective
Bargaining:
Employment of participants must not impair existing collective bargaining agreements or
written concurrence of union is required.
Payment:
Complete the Request for Payment form as needed.
Department of Labor – Year Round Youth Employment Program
Standard Definitions
Applicant
An individual who has submitted a completed application for participation in the
Youth Employment Program or the year round youth program
Cost
Allocation
The distribution of costs among cost categories to the extent of benefits received in
such categories (Indirect, Direct Program & Supportive Services, and Participant
Wages).
Cost Principles
The determination of allowable costs shall be guided by the OMB Cost Principles
associated with the particular organization
Direct Program
Services
The personnel and non-personnel costs that are related to the provision of program
services that directly benefit the participant. These costs may include personnel and
non-personnel costs directly related to providing outreach, intake, eligibility
determination, worksite supervision, and project coordination.
Eligibility
An individual is eligible for participation in the Youth Employment Program for year
round Youth Employment and Training Program if that individual was born between
7/1/88 and 7/1/95 and meets at least one of the following conditions:
 Any current WIA youth participant who was determined eligible based on
family income
 Any WIA youth determined eligible based on family income during the most
recent six months
 Any youth with a family income below 185% of the poverty level
 Any youth qualifying for fully subsidized school meal program
 Any youth qualifying for reduced subsidized school meal program
 Is a member of a family which receives Temporary Assistance for Needy
Families
 Is a member of a family which receives state administered General Assistance
(SAGA) cash payments or medical assistance
 Is a member of a family which receives SNAP (formerly known as Food
Stamps).
And
Documentation
Documentation
The following youth are eligible for the State Youth Employment Program
(appropriate documentation is outlined below):
1. Any current WIA youth participant who was determined eligible for WIA on
the basis of family income (see WIA Sec. 101 (25)), or
2. Any youth determined eligible for WIA on the basis of family income (see
WIA Sec. 101 (25)) during the most recent six-month period from intake date.
A copy of the appropriate documentation of WIA low-income eligibility (signed WIA
application with income worksheet and other documentation) must be included with
the applications.
Other applicants shall be considered income eligible if they provide any of the
following documentation:
1. A copy of a document providing proof of the individual’s eligibility for the
free or reduced price meals during the most recent school year; or
2. A copy of a federal tax return indicating the adjusted gross income falls within
185% of the federal poverty level as reported on IRS form 1040, 1040A or
1040EZ for the previous calendar year, or
3. Members of families that receive Food Stamps, cash payments under the
Temporary Assistance for Needy Families, or cash payments or medical
assistance under the State Administered General Assistance programs may
provide documentation as appropriate to their situation as noted in WIA AP
00-21 Change 6, or
4. A youth with a disability (reference WIA section 101 (25)) may provide
documentation of income and disability as outlined in AP 00-21 Change 6, or
5. As a last resort, if none of the above can be obtained, Boards may use a
statement of income and family size signed by the applicant and his/her parent
or legal guardian if he/she is a dependent of theirs. (WIBs should use a
separate self-attestation statement for youth of any age who meet this
condition).
Family
A family is:
a) a. An individual residing alone, or
b) b. A husband, wife, and dependent children, or
c) c. A parent or guardian and dependent children, or
d) d. A husband and wife.
Family Income
The adjusted gross income reported on IRS form 1040, 1040A or 1040EZ for the
previous calendar year. Any youth to be served in the year-round program must have
family income less than 185% of the federal poverty income level relative to family
size (members of families that receive SNAP – formerly known as Food Stamps, cash
payments under the Temporary Assistance for Needy Families, and cash payments or
medical assistance under the State Administered General Assistance programs are
categorically income-eligible), or eligibility for or participation in reduced or fully
subsidized school meal programs.
Poverty
Income
The income levels relative to family size that are
published annually by the Federal Department of
Health and Human Services. 185% of the Poverty
Income levels are:
# in Family
1
2
3
4
5
6
7
8
Each Add’l
Family
Member
Annual
Gross
Income
$20,036
$26,955
$33,874
$40,793
$47,712
$54,631
$61,550
$68,469
+$6,919
Hispanic
A person of Mexican, Puerto Rican, Cuban, Central or South American or other
Spanish culture or origin, regardless of race.
Indirect Costs
1. The cost of those activities, which are necessary to administer the program and
from which participants realize no direct benefit. Indirect costs may not exceed 5%.
Direct program and support services may not exceed 25%.
2. The costs of administration are that allocable portion of necessary and reasonable
allowable costs of the local board, the local municipality, and the project operator. The
costs of administration are the costs associated with performing the following
functions: accounting, budgeting, financial and cash management functions; property
management functions; personnel management functions; payroll functions, excluding
participant payroll; audit and audit resolution; general legal services; developing
administrative systems and procedures required for these administrative functions;
performing oversight and monitoring related to administrative functions; costs of
goods and services required for administrative functions; travel costs incurred for
official business in carrying out administrative functions or the overall management of
the program; awards to sub recipients or vendors that are solely for the performance of
administrative functions are classified as administrative costs.
3. Except as provided in paragraph 1 above, all costs incurred for functions and
activities of sub recipients and vendors are program costs.
Participant
An eligible individual selected for participation in the Youth Employment Program or
year round Youth Employment and Training Program.
Residence
An applicant is considered to be a resident if that individual’s regular domicile is
located within the geographic boundaries of the incorporated municipality for which
funds are allocated.
Supportive
Services
The cost of those activities which are necessary to enable an individual eligible to
participate who cannot afford to pay for such services. Supportive services may
include transportation, health care, special services and materials for the disabled,
child-care, meals, temporary shelter, financial counseling, and other reasonable
expenses required for participation in the program.
Wages
The cost of wages paid to eligible participants. Wages shall be not less than the state
minimum wage, and shall be paid only for documented hours worked.
Work
Experience
A temporary activity, which provides an individual with the opportunity to acquire the
skills and knowledge necessary to perform a job, including appropriate work habits
and behaviors.
Worksite
A work experience assignment that is consistent with terms of this agreement.
State Youth Employment & Training Program, 2009 – 2010
Program Narrative
1. Describe how these year-round funds will be used in your local area.
2. What activities will be funded?
3. How will contractors be selected? Also, list contractors if known.
4. How with these funds be coordinated with other WIA Youth funds and ARRA Youth funds?
Parties
To
Contract:
Contractor’s Name
Part I. Connecticut Department of Labor (CTDOL) Contract
Connecticut Department of Labor
CONTRACT NUMBER
200 Folly Brook Boulevard
Wethersfield, CT 06109
Telephone: (860) 263-6590
Fax: (860) 263-6216
State IRS ID No.
06 - 6000698
Contractor IRS ID No.
And Address
Contractor Representative
Payment Address
(Complete if
different)
Telephone Number
Type of Ownership (check applicable classification)
(Check each item)
Corporation Incorporated Under the Laws of the State of:
Yes
No
Minority Business
Limited Liability Company
Partnership
Governmental Entity
Women Business
Sole Proprietorship
Trusteeship
Non-Profit
Contract Start Date
Contract End Date
October 1, 2009
PURPOSE:
June 30, 2010
Total Contract Amount $
To provide State General Fund dollars in support of a Youth Employment and Training Program for SFY 09/10.
TERMS AND CONDITIONS OF CONTRACT:
The parties hereto agree that the contractor shall provide services in accordance with its proposal, which is attached and made a part
hereof. In consideration for the services to be provided by the contractor for the period shown above, the contractor will receive
reimbursement not to exceed the total amount shown above; such amount to be paid pursuant to this Contract Face Sheet (Part I),
Specific Terms (Part II), Budget Summary (Part III), and General Conditions including the State of Connecticut Assurances (Part IV),
which are a part of this contract. This is a performance-based contract and reimbursement is based on successful performance and
actual costs incurred. The State of Connecticut assumes no liability for payment under the terms of this contract, until said contractor is
notified by the Connecticut Department of Labor that said contract has received final approval. This contract is the entire agreement
between the parties hereto and may be amended only in writing by the Connecticut Department of Labor.
STATUTORY AUTHORITY: Connecticut General Statutes (CGS) Sec. 4-8, Sec. 31-3d
ACCEPTANCES: In witness whereof the parties have affixed their signatures on the day, month and year written below.
COLLECTIVE BARGAINING CONCURRENCE:
NOT APPLICABLE
Yes, (If YES, see attachment)
CONTRACTOR APPROVAL:
(Affix Corporate Seal Here)
____________________________________________________
Signature of Contractor’s Authorized Officer
__________________________
Date
____________________________________________________
Name and Title (please print or type)
CT DOL APPROVAL:
____________________________________________
Labor Commissioner
_____________________________________
AS TO FORM (ATTORNEY GENERAL)
DOL-500w (Rev 12/29/99)
_______________
Date
_____________________________
Date
_______________________________
CT DOL BUSINESS MANAGEMENT
(For Fund Availability)
_______________
Date
Connecticut Department of Labor Contract for Services
PART II - SPECIFIC TERMS (rev. 10/09)
I. Responsibilities of the Contractor: The Contractor shall administer a or year-round youth
employment project to provide employment opportunities for eligible individuals in accordance
with the following provisions:
1. Participant Eligibility – All youth served in the year-round program must have been born
between 7/1/88 and 7/1/95.
2. Participant Employment
a) Employment and training activities of participants in the Year-Round program shall
commence no sooner than October 1, 2009 and end no later than June 30, 2010. Participants
in work experience activities shall be paid the state minimum wage.
b) The Contractor agrees to ensure that the working conditions of participants shall comply with
the Occupational Safety and Health Act of 1970, all applicable Federal and State laws and
regulations pertaining to occupational safety and health, and all applicable Federal and State
laws and regulations governing the employment of minors.
c) The Contractor shall ensure that the employment of participants does not impair existing
collective bargaining agreements to which it is a party or shall secure the written concurrence
of the appropriate collective bargaining agent(s) if the employment of participants would
otherwise impair such collective bargaining agreement(s).
3. Project Budget/Use of Funds - The Contractor shall complete a Project Budget, which budget
is attached hereto and incorporated herein by reference.
4. Participant Application - The Contractor may use the Application for Participation provided
by DOL for the purpose of selecting and tracking project participants. The Contractor shall
preserve and make available to DOL all Applications for a period of three years from the date of
submission of the final expenditure report (Close-out Report) for this contract.
5. Project Reporting - The Contractor agrees to provide such programmatic and expenditure
reports and information as requested by DOL, in the format requested or using such document(s)
provided by DOL. Quarterly programmatic and financial reports are due January 20th, April 20th
and July 20th . The final reports, including the Participant Demographic Report, and close-out
package are due August 15, 2010.
6. Refund/Recoupment - The Contractor agrees to return to DOL, no later than August 15, 2010,
any funds not expended in accordance with the terms and conditions of the contract and, if the
Contractor fails to do so on demand, DOL may recoup said funds from any future payments
owing under this contract or any other contract between DOL and the Contractor or any other
contract between the State of Connecticut and the Contractor.
2009 – 2010 State Youth Employment and Training Application Instructions
Please print legibly
Items 1 - 9. Enter the applicant’s information regarding:
1. Name
2. Address
3. Social Security Number
4. Date of Birth
5. State Assigned Student ID (SASID)
6. School
7. Present Grade
8. Race/Ethnicity
9. Gender.
Item 2 - Address: Participation in the State Youth Employment and Training program may,
at the option of the local Board, be restricted to individuals who reside within the geographic
boundaries of the municipality.
Item 3 - Social Security Number: Wages earned through participation in the State Youth
Employment and Training program are reportable to the IRS and Social Security
Administration. All applicants who are chosen for participation must have a social security
number.
Item 4 - Date of Birth: Participation in the State Youth Employment and Training program is
restricted to individuals, ages 14 through 21. All applicants chosen for participation must
have been born between July 1, 1988 and July 1, 1995.
Items 5 through 7 - SASID, School, Present Grade
Item 8 - Race / Ethnicity: Check the box that most closely represents the applicant’s ethnic
or racial heritage.
Item 9 - Gender
Item 10 - Eligibility Criteria
Eligibility for participation in the State Youth Employment and Training program is based
upon economic need. Applicants who meet any of the following criteria are considered to be
economically eligible without further income verification.
 Eligible for free or reduced price lunch
 Current WIA youth participant
 Determined eligible for WIA based upon family income with 6 months of the State
Youth Employment and Training intake date
 Is a member of a family that that receive SNAP (formerly known as Food Stamps)
 Is a member of a family that that receive Temporary Assistance for Needy Families
(TANF)
 Is a member of a family that that receive State Administered General Assistance
(SAGA) cash or medical assistance.


Is a youth with a disability meeting criteria noted in AP 00-21, Change 6 provides
disability and income documentation requirements.
Is a member of a family whose income is within 185% as reported on IRS form 1040,
1040A or 1040EZ for the previous calendar year. Enter Family Size and Family
Income. Per AP 08-03, Change 1, WIBs may use a statement of family size and
income, signed by the applicants and his/her parent or legal guardian. WIBs should
use a separate self-attestation form for youth that meet this condition.
Items 11 through 13 - Signatures: The application form must be signed by the applicant. If the
applicant is 14 or 15 years of age, the application must be co-signed by a parent or guardian.
Tracking Instructions (for official use only)
14. Indicate whether the applicant was determined eligible.
15. Indicate whether the applicant was selected for participation.
16. Identify the worksite where the participant is assigned.
17. Provide a brief explanation to the types of activities the participant will perform.
18 - 19: Enter the projected Start and End Date of participation.
20. Enter the projected Hours per Week.
21. Enter the Hourly Wage.
22. Sign and date the form.
This form may be duplicated as required.