WIA-1017AFORFF (2-09) / ARIZONA DEPARTMENT OF ECONOMIC SECURITY
Employment Administration
Workforce Investment Act

WIA YOUTH PROGRAM

SERVICE DESIGN AND PROGRAM DELIVERY

PROVIDER IDENTIFICATION

LOCAL AREA / PROGRAM YEAR(S)
PREPARED BY / DATE

The following information needs to be completed during the procurement process as part of the documentation required for identifying youth program services in the local area. This information needs to be submitted as an addendum to the local area strategic plan at renewal and as changes occur with the provision of youth services.

1.Required Design Framework Components

Describe how (and by whom) each of the following required design framework components is being made available in your local area.

Intake and Referral

One-Stop Operator

Procurement

Provider’s Name

Objective Assessment

One-Stop Operator

Procurement

Provider’s Name

Development of the Individual Service Strategy (ISS)

One-Stop Operator

Procurement

Provider’s Name

Case Management Services

One-Stop Operator

Procurement

Provider’s Name
WIA-1017AFORFF (2-09)

2.Ten Required Program Elements

Describe how (and by whom) each of the following ten program elements is being made available in your local area.

Tutoring, Study Skills Training, and Instruction (leading to secondary school completion, including dropout prevention strategies)

Free of chargeProcurement

Sole-sourceIn-house provision of services

Provider’s Name

AlternativeSecondary School Offerings

Free of chargeProcurement

Sole-sourceIn-house provision of services

Provider’s Name

Summer Employment Opportunities

Free of chargeProcurement

Sole-sourceIn-house provision of services

Provider’s Name

Occupational Skill Training

Free of chargeProcurement

Sole-sourceIn-house provision of services

Provider’s Name

Leadership Development Opportunities

Free of charge

Procurement

Sole-source

In-house provision of services

Provider’s Name
WIA-1017AFORFF (2-09)

Adult Mentoring

Free of chargeProcurement

Sole-sourceIn-house provision of services

Provider’s Name

Comprehensive Guidance and Counseling

Free of chargeProcurement

Sole-sourceIn-house provision of services

Provider’s Name

Paid and Unpaid Work Experiences

Free of chargeProcurement

Sole-sourceIn-house provision of services

Provider’s Name

Supportive Services

Free of chargeProcurement

Sole-sourceIn-house provision of services

Provider’s Name

Follow-up Services

Free of chargeProcurement

Sole-sourceIn-house provision of services

Provider’s Name

Equal Opportunity Employer/Program  Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VIII), and the Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, and the Age Discrimination Act of 1975, the Department prohibits discrimination in admissions, programs, services, activities, or employment based on race, color, religion, sex, national origin, age, and disability. The Department must make a reasonable accommodation to allow a person with a disability to take part in a program, service or activity. For example, this means if necessary, the Department must provide auxiliary aids and services upon request to individuals with disabilities, such as sign language interpreters for people who are deaf, a wheelchair accessible location, or enlarged print materials. It also means that the Department will take any other reasonable action that allows you to take part in and understand a program or activity, including making reasonable changes to an activity. If you believe that you will not be able to understand or take part in a program or activity because or your disability, please let us know of your disability needs in advance if at all possible. To request this document in alternative format or for further information about this policy, contact your local office manager, TTY/TDD Services: 7-1-1.