State of Nevada
Eligible Training Provider List
Workforce Innovation and Opportunity Act

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All data entered must be Verifiable Program-Specific Performance Information.
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New Training Provider Application

1. Institution Name
2. Federal Tax ID#
3. Business License#
Please attach a copy of the license
4. Issuing Municipality
5. Provider Type
If other was selected, please specify
   
6. Contact Name (First, Last)
7. Title
8. Phone Number/Extension   ext
9. Fax
10. Email Address
11. Web Address
12. If approved, your training will be added to the State's Eligible Training Provider List. Please indicate which Local Workforce Development Board you are submitting your application to
   
MAILING ADDRESS
13. Address Line 1:
14. Address Line 2:
15. City, State, Zip , ,
16. Latitude, Longitude , Help Me Look It Up
   
17. Other ETPL: Is the institution listed as a WIOA eligible training provider in another state?
List State:
   
18. Please briefly describe below other appropriate training services your organization provides which are directly related to employment opportunities in the local area. (400 characters maximum)
   
19. Briefly describe your agency's procedures that ensure verifiable source documentation of participant's daily attendance. (400 characters maximum)
   
20. Has your training been approved by the Nevada State Commission on Post-Secondary Education?
 
If YES, please attach a copy of the licensure.
   
21. Has the training you plan to offer been accredited by an outside accreditation entity?
 
If YES, please attach a copy of accreditation.
Name of accreditation body:
   
22. Is your agency willing to offer a discount for WIOA student referrals?
Please indicate percentage or amount of discount: %
   
23. Is your agency willing to honor the costs of tuition, books, supplies, and/or fees as negotiated through this submission, for a period of 12 months?
   
24. Does your facility and/or the facility where the training will be conducted meet all physical site requirements under the Americans with Disabilities Act and is it accessible to persons with disabilities?
   
25. Can your agency assure that it will employ instructors who meet the qualifications for training and/or who have the certifications required to train participants in the training indicated in this application and as indicated in your training description?
26. Can your agency assure that the credential a participant receives upon completion of this training is an industry recognized credential? (certificate, diploma, credits toward a degree, degree, etc.)
27. Name of the credential and the industry that recognizes it:
   
28. Provide a brief overview of your agency (400 characters maximum). Include the mission, purpose, and any experiences and/or capabilities in operating training services that are directly related to employment opportunities. Also, include any past and/or present experiences and/or capabilities in regard to providing training services for WIOA eligible participants.
   
29. To be listed on the ETPL the training provider must have a Refund/Reimbursement Policy. What is your agency's policy? Note: When reimbursing training funds that come from multiple funding streams including WIOA, WIOA funds require reimbursement at the actual rate paid, prorated in relation to the actual training duration, less the proportionate rate of the provider's cancellation fee. In other words, when you reimburse training funds it needs to be done in an equitable and proportional way across the multiple funding streams. (400 characters maximum)
   
30. As described in WIOA section 116 (b)(2)(A)(i)(I)-(IV), and if placed on the Eligible Training Provider List (ETPL), every year your organization will be required to meet and provide verifiable information pertaining to the following indicators of performance for all individuals who complete the training:
  • Percentage of participants who are in unsubsidized employment during the second quarter after completion (minimum expectation will be 34%)
  • Percentage of participants who are in unsubsidized employment during the fourth quarter after completion (minimum expectation will be 33%)
  • Median earnings for those who are in unsubsidized employment during the second quarter after completion (minimum expectation will be $3,480)
  • Percentage of participants who obtain a recognized postsecondary credential within one year after completion (minimum expectation will be 20%)
  • The total number of individuals who complete the training
Will your organization be able to meet the performance indicators and reporting requirements above, by January 01, 2017 and subsequently, on all recertification’s?
If your answer was NO, please attach a PDF document here that outlines:
  • Which data you WILL be able to provide by January 1, 2017
  • What steps you WILL take towards being able to provide the missing data
  • What date you WILL be able to provide the missing data
   
31. Please provide a description of any partnership(s) your organization currently has with businesses/local employers (400 characters maximum). Make sure to include indicators of quality and quantity describing the employer partnership(s).
   
Eligible training providers are subject to the equal opportunity and nondiscrimination requirements contained in Section 188 of WIOA.

Accompanying information must not reveal personally identifiable information about an individual participant. In addition, disclosure of personally identifiable information form an education record must be carried out in accordance with the Family Educational Rights and Privacy Act (FERPA) (20 U.S.C & 1232g; 34 CFR Part 99) including the circumstances relating to prior written consent.
   
IF a Training Provider is determined to have intentionally omitted or has provided inaccurate information, or subsequently violated any provisions under the Workforce Innovation and Opportunity Act WIOA Regulations, Federal, State or Local Law, the State Agency shall take appropriate action up to and including termination from the ETPL. If the lead state agency determines it just and appropriate, Training Provider shall repay costs during the period of noncompliance. (Section 122 (f)(1)(A)(B)(C)(2), NPRM Part 680.460, Part 680.480, SCP 1.12, 1.13)
   
I certify to the best of my knowledge and belief, the data information in response to this application's questions, to be true
and correct. I understand that non-responsive applications, as determined by the State, may not be considered for
approval on the ETPL. Furthermore, I certify that the submission of this application ensures compliance with all
designated assurances herein, as well as applicable WIOA, State, and Federal regulations. I further certify that the total cost of each training presented in this application shall include a breakdown of any and all other cost that will be incurred to
provide this training, less any discount offered to the State and that all source documentation related to these costs shall
be subject to full disclosure and review at the request of the State.
   
CERTIFICATION REGARDING DEBARMENT
SUSPENSION, INELIGIBILITY and VOLUNTARY EXCLUSION of LOWER TIER COVERED TRANSACTIONS
This certification is required by the regulations implementing Executive Order 12549, Debarment and
Suspension, 29 CFR Part 98, Section 98.510
   
1. By signing and submitting this proposal, the prospective recipient of Federal assistance funds is providing the certification as set out herein.
2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective recipient of Federal assistance funds knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the Department of Labor (DOL) may pursue available remedies, including suspension and/or debarment.
3. The prospective recipient of Federal assistance funds shall provide immediate written notice to the person to which the proposal is submitted if at any time the prospective recipient of Federal assistance funds learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.
4. The terms "covered transaction", "debarred", "suspended", "ineligible'', "lower tiered covered transaction", participant", "person", 'primary covered transaction", "principal", "pre-vocational skills", "proposal", and "voluntary excluded", as used in this document, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549, Debarment and Suspension, 29 CFR Part 98, Section 98.510. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations.
5. The prospective recipient of Federal assistance funds agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tiered covered transaction with a person who is disbarred, suspended, declared ineligible, or voluntary excluded from participation in this covered transaction, unless authorized by the DOL.
6. The prospective recipient of Federal Assistance funds certifies by submission of this proposal, that neither it nor its principles are presently disbarred, suspended, proposed for disbarment, declared ineligible, or voluntary excluded from participation in this transaction by any federal department or agency.
7. Where if the prospective recipient of Federal Assistance funds is unable to certify to any statements in this certification, the prospective recipient shall attach if applicable, an explanation, on a separate page, to this proposal.
   
Name of authorized representative
Title of authorized representative
   
By typing my name in the following box I certify the above statements to be verifiable, true and correct, to the best of my
knowledge, and that this information can be used for the purpose of processing this application.
Signature of authorized representative
Date   mm/dd/yy
   
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