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F <br />R <br />AGENCY EXPERIENCE VERIFICATION FORM <br />To be completed by the agency applying for the WIOA Youth funds. <br />A. <br />RFPApplicant: <br />No <br />1. <br />Funding Agency Name: <br />2. Contact Person & <br />Telephone #: <br />3. <br />Contract Period: <br />4. Types of Funds: <br />5. <br />Amount Received: <br />6. Amount Spent: <br />7. <br />Contract Activities: <br />8. Years Working with <br />this Funding Source: <br />To be completed by the Agency that currently funds or has funded <br />the RFP Applicant labeled in Section A. <br />B. Administrative Experience <br />Yes <br />No <br />Comments <br />1. <br />Has the agency shown the capability to successfully administer grant <br />funds and meet contracted goals. (If "No," provide comments) <br />2. <br />Has the agency successfully resolved performance problems in a <br />2. <br />timely manner. (If "No," provide comments) <br />3. <br />Has the agency consistently submitted complete and accurate <br />records and reports in a timely manner. (If "No," provide comments) <br />4. <br />Have there been any findings of irregularities regarding the agency, <br />its officers, its Board of Directors. (If "Yes," provide comments) <br />5. <br />Has the agency had costs questioned by an audit or monitoring <br />review. (If "Yes," provide comments) <br />6. <br />Does the agency have unresolved disallowed costs. (If "Yes," provide <br />comments) <br />C. Probation Sanction <br />Yes <br />No <br />Comments <br />1. <br />Has the Applicant /Lead Agency been placed on probation in <br />any program it has administered through your funding source. <br />(If "Yes," provide comments) <br />2. <br />Has the Applicant /Lead Agency been sanctioned or had <br />program funds de- obligated in any program it has <br />administered through your funding source. (If "Yes," provide <br />comments) <br />Page 1 of 2 <br />19D-39 35 <br />