Ottawa County Federal Tax Id Number

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					                                             Ottawa County Michigan Works – Business Services
                             Incumbent Worker Training Program Grant Application – PY 2010/2011


                                                                                              MWA Admin. Only
SECTION 1. COMPANY INFORMATION:                                                               Date_____
                                                                                              IW#______
(TYPE AND TAB ONLY! DO NOT HIT ENTER)
Company Name:

Street/Mailing Address:

City:                          Zip:                              County:

Company Contact Person:                                          Title:

Phone:                         Ext.                              Fax:

Email Address:                                                   Website Address:



Date of Inception:             Years in business:                Total number of full-time employees:

Legal structure of business:                  Sole Proprietor             Partnership          Corporation

Employer’s Federal ID #:
Is your company current on all State of Michigan tax obligations?               Yes            No

What did your company spend on training in last budget year:
$

Is your company receiving/applying for other training funds?                    Yes            No

If yes explain:




Description of your business, products(s) and /or services(s):




Amount of grant request: $                     Number of full-time employees to be trained:
                          Approval of grant will be based upon availability of funds.

Training Start Date:                           Training End Date (no later than 6/30/11):

Employers will be expected to begin training and incur expenses within three (3) months of the
award. Expenses cannot be incurred prior to approval. The Michigan Works Agency reserves the right
to reduce training funds of employers who do not begin training and incur expenses within three (3)
months of the award.

                                                        -1-
                                             Ottawa County Michigan Works – Business Services
                             Incumbent Worker Training Program Grant Application – PY 2010/2011



SECTION 2. NEEDS ASSESSMENT:
Employers are required to conduct a needs assessment that identifies the specific skills or processes that
are needed for the job or industry; the skills or process gap that exists in the employer’s current labor
force or industry; and the type of training proposed to address the skills or process gap. If the need for
training is targeted to a large segment of the employer’s workforce, then the appropriate level of
assessment is a group assessment to demonstrate why that segment of the workforce needs the
identified training. If the training is targeted to an individual, then the appropriate assessment is an
assessment of the individual’s need for training.

What are the skills/processes needed?




Where are the skills/process gaps?




What type of training is being proposed to bridge the gap?




How does this proposed training help to prevent potential layoff(s)?




Identify the type of assessment tool used to determine the gap (attach a copy of the needs assessment if possible).




What would occur is this application for funding is not approved? Would the training happen anyway or would happen
in a limited scope? If it would not happen what is the potential implication(s)?




                                                         -2-
                                             Ottawa County Michigan Works – Business Services
                             Incumbent Worker Training Program Grant Application – PY 2010/2011


Additional Justification for Repeat Applicants:


Has your company received Incumbent Worker Training funds in the past?                 Yes                   No


If yes, what year and how much did you receive:

What were the outcomes/impacts of the previously funded Incumbent Worker Training for the company as well as the
trainee(s)?




If your company received IW funds previously, provide additional justification of the continued need for training, update
the needs assessment, and if any of the trainees received training with IW funds in the past, provide written
documentation that this training plan is not a duplication of past training..




                                                         -3-
                                               Ottawa County Michigan Works – Business Services
                               Incumbent Worker Training Program Grant Application – PY 2010/2011


SECTION 3. TRAINING COURSES & TRAINING PROVIDER INFORMATION:
Use Attachment A for additional courses

                                           Type of Training (see list
Course Name:                                                                  Course Start & End Dates:
                                           below):


Training will be                                            At the training
                                 On-site                                                   At a remote location
delivered:                                              institution
Name of selected training provider(s):

Description of Training:

Number of Training Hours:                                                     Number of Employees to be Trained:

Instructional Cost (indicate per hour or flat fee):                           Material Cost (if applicable):




                                           Type of Training (see list
Course Name:                                                                  Course Start & End Dates:
                                           below):


Training will be                                            At the training
                                 On-site                                                   At a remote location
delivered:                                              institution
Name of selected training provider(s):

Description of Training:

Number of Training Hours:                                                     Number of Employees to be Trained:

Instructional Cost (indicate per hour or flat fee):                           Material Cost (if applicable):

Types of Training, Examples include, but are not limited to:
    Applied Academics: Mechanical and business mathematics;
    Equipment Specific: Training performed for specific equipment/machinery (i.e., robotic, CNC);
    Maintenance/Trades: Blueprint reading and welding;
    Managerial: Leadership and supervisor training;
    Process Improvement: Training performed to improve the employer’s operational and/or functional process
       (i.e., QS 9000, Lean Manufacturing, Six Sigma);
    Technical: Welding, PLC, CAD/CAM, Pro-E, SPC, FMEA.

Provide justification for selection of training provider(s) based on valid quality, cost &/or delivery factors:




                                                            -4-
                                             Ottawa County Michigan Works – Business Services
                             Incumbent Worker Training Program Grant Application – PY 2010/2011

SECTION 4. TRAINING PROGRAM BUDGET:
Note: Training funds cannot be used to reimburse any training costs incurred before the grant is approved.
Please take this into account when developing your budget and timeline.
                                                     B.                       C.                      D.
                  A.
                                               IWT ASSISTANCE             EMPLOYER                  TOTAL
           BUDGET CATEGORY
                                                 REQUESTED               CONTRIBUTION               (B+ C)
 1. Instructor Wages/Tuition
 Note: This information should reconcile
 with Section 2 Training Courses &
 Training Provider Information.
                                               $                     $                         $       Training
                                               $                     $                         $       Support
 Examples:
                                               $       Total         $       Total             $       Total
    1) Injection Molding $500 x (5)
       =$2500
    2) 2) XYZ Training $25/hr x 24
       hours= $600 Sub Total = $3,100

                                                Cannot fund with
 2. Curriculum Development                                           $                         $
                                                IWT grant funds

 3.Materials/Supplies Textbooks (itemize)      $
                                                                                               $
 Example: (10) XYZ Manuals @ $30 each =        $                     $
                                                                                               $       Total
 $300                                          $       Total


 4. Training Equipment Purchase                 Cannot fund with
                                                                     $                         $
 (employer contribution)                        IWT grant funds

                                               Cannot fund with
 5. Other Costs (describe)                                           $                         $
                                               IWT grant funds
                                                Cannot fund with
 6. Travel, Food, Lodging                                            $                         $
                                                IWT grant funds
                                                                     $                         $
 7. Trainee Wages (for employers with 50        Cannot fund with     $                         $
 or fewer employees only)                       IWT grant funds      $       Total             $       Total

 8. TOTALS                                     $                     $                         $

ALLOWABLE COSTS / EMPLOYER MATCHING FUNDS
    Only costs directly related to instruction and materials to conduct the training will be allowable charges to the
     grant. All costs must be properly supported with back-up data and documentation.
    Employers must provide a dollar-for-dollar match.
    Employers with 50 or fewer total company employees may use employee wages during the training as part
     of the match.
    The cost of equipment or software purchased specifically for use in the proposed training can be used for
     employer match andmust be pre-approved by MWA Business Services to be considered employer match.
    Travel expenses for the trainer or trainee may be counted as employer match but must be pre-approved by
     MWA Business Services.
    Administrative fees paid by the employer to an outside agency to conduct the employer needs assessment
     or assessment fees paid to determine skill level(s) of employees may be used for employer match as it
     relates to the Incumbent Worker training plan.
    All invoices and back up documentation is due to MWA Business Services Rep by June 30.

                                                        -5-
                                             Ottawa County Michigan Works – Business Services
                             Incumbent Worker Training Program Grant Application – PY 2010/2011


SECTION 5. ANTICIPATED OUTCOMES OF THE TRAINING PROJECT:
 Please check the boxes that apply to the anticipated outcomes of the proposed training project..

      Will save       jobs                                     Critical to long-term/short-term viability

      Will create      new jobs                                Will make the company competitive

      Will lower employee turnover                             Will increase profitability


Provide a brief statement explaining “how” and/or “why this training would result in the specific outcomes proposed
above:




SECTION 6. EMPLOYER CERTIFICATION BY AUTHORIZED COMPANY REPRESENTATIVE:

             Note: The individual signing the application below must have authority to enter into
                                contracts on behalf of the applying business.

As an authorized representative of the business listed above, I hereby certify that the information listed above and
attached to this application is true and accurate and 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.

The Employer(s) certify the following:
      That the training is necessary because the employer(s) are experiencing a decline; have the potential to
   undergo layoffs, or are experiencing a skills gap that impacts their ability to compete, retain workers, and
   expand;
      To provide the required dollar for dollar matching funds indicated in the proposal;
      To post job orders and register open positions to the Michigan Talent Bank.


 Signature:
                                                           Title:

 Print Name:                                               Date:

APPLICATIONS ARE DUE THE LAST WEDNESDAY OF EVERY MONTH. PLEASE ALLOW AT LEAST
            15 BUSINESS DAYS FOR YOUR APPLICATION TO BE PROCESSED.

                                       Mail or deliver One (1) original to:
                                            Business Services Unit
                                       Ottawa County Michigan Works!
                                         115 Clover Street, Suite 200
                                               Holland, MI 49423

How did you learn about the Ottawa County Michigan Works Incumbent Worker Training Program?


                                                         -6-
                                               Ottawa County Michigan Works – Business Services
                               Incumbent Worker Training Program Grant Application – PY 2010/2011


                                                                                                               Attachment A

                                           Type of Training (see list):
Course Name:                                                                  Course Start & End Dates:



Training will be                                            At the training
                                 On-site                                                   At a remote location
delivered:                                              institution
Name of selected training provider(s):

Description of Training:

Number of Training Hours:                                                     Number of Employees to be Trained:

Instructional Cost (indicate per hour or flat fee):                           Material Cost (if applicable):



                                           Type of Training (see list):
Course Name:                                                                  Course Start & End Dates:



Training will be                                            At the training
                                 On-site                                                   At a remote location
delivered:                                              institution
Name of selected training provider(s):

Description of Training:

Number of Training Hours:                                                     Number of Employees to be Trained:

Instructional Cost (indicate per hour or flat fee):                           Material Cost (if applicable):


                                           Type of Training (see list):
Course Name:                                                                  Course Start & End Dates:



Training will be                                            At the training
                                 On-site                                                   At a remote location
delivered:                                              institution
Name of selected training provider(s):

Description of Training:
Number of Training Hours:
                                                                              Number of Employees to be Trained:
Instructional Cost (indicate per hour or flat fee):
                                                                              Material Cost (if applicable):




                                                            -7-

				
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