Add instruction here on why fill the form, what documents are needed etc

links to required forms could be added here:

• Form 1 (link pdf)
• Form 2 (link pdf)

1 Step 1

Training Provider Application

Name of Training Organization

Federal Tax ID

Primary addressPrimary address

State

ZIP

URL

Type of Businesspick one!

Select An OptionNone Selected College/University Post-Secondary Educational Institution - Public Post-Secondary Educational Institution - Private Local Public School - 12th Grade and Under Local Private School - 12th Grade and Under Local Charter School - 12th Grade and Under Alternative Secondary Education School - 12th Grade and Under Health Care Community Based Organization - Church Community Based Organization - Non-Profit Federal Government Agency State Government Agency Local Government Agency Private Employer Service/Goods Vendor Not Otherwise Classified Trade Association Registered Apprenticeship One-Stop Office State Approved Apprenticeship

Type of Entity

Select An Option1 = Higher Ed: Associate’s Degree2 = Higher Ed: Baccalaureate or Higher3 = Higher Ed: Certificate of Completion4 = National Apprenticeship5 = Private Non-Profit6 = Private For-Profit 7 = Public8 = Other

Is this an accredited postsecondary institution

YesNo

Registered Apprenticeship provider

YesNo

Name & Title of Contact Person:

Billing AddressSame as mailing or physical location?

YesNo

Billing Address

Billing contact

Mailing locationSame as primary address

YesNo

Mailing Addressyour home / office

Mailing contact

Institution Area

CityCountyOut of State

Institution typepick one!

Select An OptionNone Selected Adult Education & Family Literacy Apprenticeship Programs Aviation and Flight Schools Community College Cosmetology/Barber Training Provider Four-year Colleges and Universities Graduate Programs Hospital or Health Programs Job Corps JTPA Programs Law Enforcement Academies Not Available Other education and training institutions Private Business and Technical Schools Public Adult Schools with occupational programs Secondary Schools State-defined Institution Types State-defined Institution Types Technical College Campus Two-year, Technical, and Community Colleges

Institution ownership

N/APrivate for-profitPrivate non-profitPublic institutionUnknown

Years in business

Disabled access

YesNo

ADA compliant

YesNo

Email address of contact person

email

Phone number of contact person

Source of funding

Institution description

Is this institution a community college

YesNo

Display online to the public?

YesNo

Eligible provider of Youth Workforce Investment Activity

Contact PersonIf different from above

Title

Telephone

Fax

Email

email

Does your organization provide job search assistance or placement services?

YesNo

If yes decribe services

0 /

Does your organization have a tuition refund policy?

YesNo

If yes, attach the policy including time frames and percentage of reimbursementupload

cloud_uploadUpload

Name of Financial Aid Contact Person

Email Address of Financial Aid Contact Person

email

Please provide three customer references including contact information:

Reference 1more details

0 /

Reference 2more details

0 /

Reference 3more details

0 /

Submit Form

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