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INSTRUCTIONS (Effective February 2012)

EMPLOYMENT AND TRAINING FUND (ETF) PROGRAM'S

EMPLOYER REFERRAL & COURSE REGISTRATION AGREEMENT FORM

IMPORTANT: ALL REQUESTS MUST BE SUBMITTED TO ETF BY THE EMPLOYER ON

OFFICIAL STATE FORMS LOCATED ON THE ETF WEBSITE AT

Employers are required to contribute 50% of the ETF assistance provided by the Department of Labor & Industrial

Relations (DLIR/ETF). Before applying, review these instructions and contact the vendor of choice. All requests for

training under the Employer Referral Program must be submitted on official state forms located on the ETF website at

Unofficial forms which do not contain the official State Workforce Development Divison

(WDD) logo will not be accepted by WDD local offices. Complete and sign the two-page agreement form, and submit to

the WDD local office (see ETF website ). If submitting forms via fax or email, please contact

the local office to verify receipt of your request. Upon receipt, ETF will determine eligibility and, if approved, will

forward the registration to the training vendor to confirm enrollment. ETF will then fax the registration back to the

employer and vendor giving its final written approval. The employer and vendor must arrange payment prior to start date

of class. Government workers are not eligible for ETF assistance.

Employer Referral Agreement (Page 1 of 2)

• Both the employer and employee must sign the agreement forms before submitting. These forms must be received by

ETF at least two weeks prior to the start date of the class. The employer's cost is 50% of the assistance and any excess

balance thereof, including tax, if applicable, and must be paid directly to the ETF training vendor prior to the start date

of the class. Some vendors have discounts and/or may not charge tax, so contact vendor first to obtain exact prices. Be sure

to ENTER the employer's DOL # (

) assigned by the Unemployment Insurance Division for payroll purposes.

Dept. of Labor

If the employer's payroll services are contracted to an outside agency then the DOL # for the payroll service provider shall be

provided along with the provider's name.

Course Registration Agreement (Page 2 of 2)

CONTACT VENDOR FOR EXACT PRICE INFORMATION.

• Section I & Section IV. Employer must complete both Sections I and IV. Course prices should be exact amounts, so check

with vendor; otherwise, there may be delays in approving your registration. ETF assistance will cover 50% of the tuition

costs up to a tuition cap of $500 per course, tax inclusive. The employer must pay for the remaining 50% of tuition costs

plus any excess balance which exceeds the $500 tuition cap, directly to the vendor. FOR EXAMPLE, if the vendor's price

for an ETF approved course is $200, then ENTER $100 in both the DLIR/ETF and Employers' cost columns. However, if

the price exceeds the tuition cap and is $700, then ENTER $250 for DLIR/ETF and $250 for the Employers' cost (DO NOT

add tax, it is already included), and ENTER the excess of $200; making the total employer's cost $450.00.

Sample Chart:

BREAKDOWN OF TUITION COST

Employer's cost:

Excess Balance:

DLIR/ETF costs:

Total Employer

(paid by employer

(50% ETF assistance

Total Tuition

(50% ETF assistance)

Cost:

directly to vendor)

pay directly to vendor)

$100

$ 100

$100.00

Course 1

$ 200.00

$250

$200

$ 250

$450.00

Course 2

$ 700.00

$200

$ 350

$350

$ 900.00

$550.00

Total

IMPORTANT: Contact the training vendor directly for more information on ETF approved courses and exact

tuition amounts (some vendors provide a tuition discount to the State, which is different from their published prices).

• Section II and IV. To be completed and signed by the Training Vendor.

• Section III. To be completed by ETF.

• Section IV. This section must be completed by both the employer and training vendor. Enter the employer's cost of 50% of

the assistance plus any excess balance, including tax, if applicable. The employer must sign and date this section before

submitting to ETF. Upon receipt, ETF will determine eligibility and then forward the registration to the vendor to confirm

enrollment. ETF will forward its written approval to both the employer and vendor. Employer must contact vendor directly

to arrange payment. All requests must have the correct tuition amount(s) stated on the course registration agreement form.

►

Any modifications to an already approved form must be

resubmitted on new Employer Referral and Course Registration

Agreement forms with the authorized signatures and received by ETF 1 week prior to start date of the class. To attend a

class that has been canceled by the vendor & rescheduled to another date, course title, price, & hours must remain the same.

Complete/sign the ETF "Requesting a Change in Course Schedule (RCCS)" form (see ETF website

Revised February 2012

Employer Referral Agreement - Department Of Labor And Industrial Relations (Dlir), Workforce Development Division (Wdd) Page 3

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