Form Wrc - Worker Retraining Tax Credit Application Page 2

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Schedule 1
Worker Retraining Tax Credit Application for
Tax Year Ending
Form WRC
Noncredit Courses to be Approved by VEDP
,
Complete a Schedule 1 for each course.
Page
of
Name as it Appears on Form WRC
FEIN or SSN
List each noncredit course from a Virginia community college or a school approved by the
This section to be completed
Virginia Economic Development Partnership for purposes of claiming this credit. Complete
by the Virginia Economic
a separate Schedule 1 for each course. See the definition of "eligible worker retraining"
Development Partnership.
in the instructions before completing this schedule.
Course is:
A.
Name of School
Contact
Approved
Type (Check One)
Phone Number
Community College
Private School
Not Approved
B.
Course Title
Course Number
C. Course Description, Including Dates, and Prerequisites:
Signature
Name Printed
Phone
A qualified employee cannot be a relative of any owner or the
Qualifying Employees Taking Qualifying Noncredit Courses
employer claiming the credit and cannot own, directly or indirectly, more than 5% in value of the outstanding stock of a corporation
claiming the credit. See the "Qualified Employee" section of the instructions.
Column A
Column B
Column C
Column D
Column E
Employee Name and SSN
Date Paid
Credit Requested*
Date Course
Course Cost
Completed
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Total for This Page
Enter on Page 1 Only - All Other Page Totals Combined
Enter in Part II, Form WRC, Total of All Pages
* 30% of Column C costs or, if a private school, up to $200 per qualified employee annually ($300 per qualified employee annually if the
eligible worker retraining includes retraining in a STEM or STEAM discipline).
Attach this schedule to Form WRC along with a copy of all documentation used to complete this form including enrollment forms from
the school showing classes taken and payments made.
Page 2

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