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<br />Page 7 of 7 <br /> <br />Signature Page <br /> <br />By signing below, the local CEO and Local Board chair request approval from the Governor to be <br />an Adult and Dislocated Worker Career Services Provider. Each party certifies that this <br />application submission was reviewed and demonstrates that the Local Board or administrative <br />entity will meet all the requirements as an Adult and Dislocated Worker Career Services <br />Provider under WIOA law and regulations. <br /> <br />Instructions <br />The Local Board chair and local CEO must sign and date this form. Include the original <br />signatures with the request. <br /> <br />Local Workforce Development Board <br />Chair <br /> Local Chief Elected Official <br /> <br />Signature Signature <br />Stacey Sanchez Vicente Sarmiento <br />Name Name <br />Chair – Santa Ana WDB Mayor – City of Santa Ana <br />Title Title <br /> <br />Date Date <br /> <br />EXHIBIT 1