All Fields are Required
Company/Open Enrollment:
Authorized Company Representative Name:
Company Representative Phone Number:
Company Representative Email Address:
Company Address:
City:
State: AL AK AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Not Listed
Zip Code:
Target Business/Industry:
Job Preparation:
Placement Opportunity:
Employee Upgrade:
Average Wage:
Wage Increase:
Program Title:
Training Proposed: (description)
Training Proposed Start Date:
Training proposed End Date:
Unduplicated Headcount:
Contract Hours Proposed:
Number of Sessions:
Instructor/Vendor Name:
Instructor/Vendor Phone Number:
Instructor/Vendor Email Address:
Location of Training:
Tuition:
Employer Contribution:
Administration Fees:
Instructional Supplies:
Instructor Fees:
Other Identified Fees:
As recipient of a CTE STIT funds, I attest that I have read and agree to comply with the STIT Guidelines and Procedures, which include the terms and conditions of the award. I further acknowledge that failure to comply with these terms and conditions may result in consequences and/or penalties, including withdrawal of the funds.