ITA/OJT WAIVER REQUEST
TO EXCEED THE LIMIT FOR ITA/OJT TRAINING
For use with WIOA Funded Training (excluding Participant Reimbursement)
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Adult - 201
Dislocated Worker - 501
Other:
The ITA cap shall not exceed $5,000 for any customer for in-demand occupations. For occupations that are higher in-demand, the ITA request for a higher amount may be requested on a case-by-case basis. (Request must be submitted to the OWDB Program Analyst).
WAIVER REQUEST DATE:TRAINING PROVIDER/EMPLOYER: / CALJOBS VENDOR ID: / PY: / --Select--16/1717/1818/19
ADDRESS: / CITY: / STATE: / CA / Zip:
CONTACT: / TITLE:
PHONE: / FAX: / EMAIL:
WIOA REGISTRANT: / WIOA APP ID#: / SSN4: / ENROLL DATE:
WIOA REGISTRANT’S PHONE: / CENTER: / CENTER PHONE:
CASE MANAGER: / CASE MANAGER EMAIL: / FAX:
TRAINING FROM: / To: / SUPPORTIVE SVCS ALSO REQUESTED: / INDUSTRY SECTOR: / --Select--Advanced ManufacturingHealthcareTransportationDistribution & LogisticsICT/Digital MediaOther
Total Training Cost: / $
REASON FOR WAIVER (500 Character Maximum)
SITE MANAGER APPROVAL (500 Character Maximum)
By signing and transmitting this ITA/OJT WAIVER REQUEST, the undersigned intends that KRA Corporation rely upon and act in accordance with all of the information contained herein. The AJCC is certifying to the accuracy of the information being supplied on this document. You must notify KRA of any changes in customer activities, and/or any discrepancies in support documents affecting this ITA/OJT WAIVER REQUEST. If applicable, by signing this form, the Oakland WDB Staff member is approving the training expenditure and authorizing the use of such funds for the said trainee.
Case Manager: / Site Manager:PRINT NAME: / Date / PRINT NAME: / Date
TITLE: / TITLE:
OWDB—DESIGNATED SYSTEM ADMINISTRATOR APPROVAL (For OWDB Staff Use Only)
Waiver approved to exceed $5,000 in the total amount of / $ / OWDB Staff:
Waiver approved to exceed $5,000 in the total amount of / $ / PRINT NAME: / Date
Waiver NOT approved to exceed $5,000 / TITLE:
Page 1 of 1 Revised: 2/28/2017 – KRA2017