Georgia Retraining Tax Credit Program Approval Application - Department Of Technical And Adult Education

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Program Approval Application
Page 1 of 2
Georgia Retraining Tax Credit
Program Approval Application
Georgia Department of Technical and Adult Education
Training Program ______________________________________
Complete this application and submit to the Vice President, Economic Development Programs at your local Technical College or Institute.
1. Company Name: ____________________________________
Division: _______________________
Address: __________________________________________
Phone: _________________________
_________________________________________________
Contact: _________________________
No. of years operating in Georgia: ________
No. of employees in division location: ________
2. Type of business and nature of operation: ___________________________________________________________
____________________________________________________________________________________________
3. Describe relevant changes in your workplace/market and list the resulting skills deficiencies including projected number of employees to be trained:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
4. Describe purpose and objectives of retraining:
______________________________________________________________________________________________
______________________________________________________________________________________________
5. Provide estimated retraining costs: _________________
6. Are employees unable to function effectively on the job as a result of the skill deficiencies identified in item 3? _________
Will the deficiencies result in employee displacement if skills are not enhanced? __________
7. Name of training provider: _________________________________________________
____________________________________________________
Signature of Company Chief Executive
________________________________________________
Date
____________________________________________________
Title
This is to certify that the Retraining Program for the above named company is in compliance with standards established by the Department of
Technical and Adult Education.
____________________________________________________
Signature of Department of Technical and Adult Education Official
_________________________________________________
Date Approved
____________________________________________________
Name of Technical College or Institute
A copy of this form and associated information is available as an
Adobe Acrobat PDF file
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12/28/00

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