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ETPL POLICY AND PROCEDURES <br />ATTACHMENT 3 <br />ETPL LOCAL BOARD DELEGATION AND CANCELATION FORM <br />A Local Workforce Development Board (Local Board) may delegate or cancel responsibility of the <br />California (CA) and local Eligible Training Provider List (ETPL) to an appointed Local Board by <br />completing this form. This form must be completed at the time of a change (delegation or <br />cancelation), and annually in July to ensure the State ETPL Coordinator is able to coordinate with <br />the appropriate Local Board. <br />Please sign (physical or electronic) and submit the completed form to the Employment <br />Development Department via email to WSBETPL@edd.ca.gov. <br />Select either the Delegation or Cancelation box: <br />DELEGATION — Delegating Local Board is assigning responsibility for the CA and local ETPL <br />to the Appointed Local Board, and the Appointed Local Board agrees to coordinate the CA and <br />local ETPL on behalf of the Delegating Local Board. Signatures are required of the Delegating and <br />Appointed Local Board's Executive Director. <br />CANCELATION — Delegating Local Board is revoking responsibility for the CA and local ETPL <br />to the Appointed Local Board. The Delegating Local Board will resume responsibility for the CA <br />and local ETPL unless a new Local Board is assigned this responsibility. Signatures are required of <br />the Delegating and Appointed Local Board's Executive Director. <br />Delegating Local Board: <br />Name: <br />Delegating Local Board Executive Director <br />Signature: <br />Appointed Local Board: <br />Appointed Local Board Executive Director <br />Name: <br />Signature: <br />Date: <br />Date: <br />I <br />WSD21-03 Page 1 of 1 <br />