Form Wrc - Virginia 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 VDBA
,
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 Department of Business Assistance for purposes of claiming this credit. Complete
by the Virginia Department of
a separate Schedule 1 for each course. See the definition of "eligible worker retraining"
Business Assistance.
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
Qualifying Employees Taking Qualifying Noncredit Courses
A qualified employee cannot be a relative of any owner or the
employer claiming the credit and cannot own, directly or indirectly, more than five percent in value of the outstanding stock of a corporation
claiming the credit. See "Qualified Employee" section of instructions.
Column A
Column B
Column C
Column D
Column E
Employee Name and SSN
Date Course
Course Cost
Date Paid
Credit Requested*
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 Col. C costs or, if private school, up to $100/employee.
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 payment made.
Page 2

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