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ETPL POLICY AND PROCEDURES ATTACHMENT 4 <br /> CA ETP ASSURANCES FORM <br /> A completed and signed California (CA) Eligible Training Provider (ETP) Assurances Form must be <br /> uploaded to the documents section of the Provider Profile in CaIJOBS. This form must be uploaded <br /> annually, prior to the provider being reviewed for eligibility. <br /> Part A. <br /> I certify that Jlnsert Name of School/Organizationl: <br /> (a) Is a legal entity, registered to do business in the state of California (CA). <br /> (b) Has not been determined to be ineligible to receive federal funds. <br /> (c) Is in compliance with Workforce Innovation and Opportunity Act Section 188 and Title 29 Code <br /> of Federal Regulations Part 38. <br /> (d) Has demonstrated effectiveness in operating occupational classroom or distance training <br /> program(s). <br /> (e) Agrees that training provider facilities, classroom instruction, relevant financial records, and <br /> attendance records may be reviewed by state, federal and/or local monitors or auditors to <br /> ensure compliance with funding requirements. <br /> Part B. <br /> I certify that I: <br /> (a) Have reviewed the annual student data reporting requirements for the Eligible Training <br /> Provider Performance Report (ETP Report) established for training providers. Please refer to the <br /> ETP Report Required Data listed below. <br /> (b) Will begin collecting required student data elements that are not currently being collected. <br /> (c) Will report and submit the ETP Report data for all students trained in each of my <br /> school/organization's training programs listed as approved on the Eligible Training Provider List <br /> (ETPL)to the Employment Development Department by the due date. <br /> I understand that my school/organization's application for program approval on the CA ETPL will not be <br /> processed without receiving this Eligible Training Provider Assurances Form. <br /> Name of Training Provider (School/Organization) <br /> Mailing Address <br /> City, State, Zip Code <br /> Phone Number (###) ###-#### <br /> Print Name of School/Organization Representative <br /> Title of School/Organization Representative <br /> Signature of School/Organization Representative Date <br /> WSD21-03 Page 1 of 2 <br />