1. 2. Facility Name: Facility Name: Street Address: Street Address: City, State, Zip: City, State, Zip: Special Notes/Comments: Special Notes/Comments: 3. 4. Facility Name: Facility Name: Street Address: Street Address: City, State, Zip: City, State, Zip: Special Notes/Comments: Special Notes/Comments: 5. 6. Facility Name: Facility Name: Street Address: Street Address: City, State, Zip: City, State, Zip: Special Notes/Comments: Special Notes/Comments: I certify that I am an authorized representative of the applicant institution seeking eligibility for the Eligible Training Provider List. I acknowledge that initial eligibility will be granted to each program for a 12-month period if approved. After the initial period of eligibility, each eligible program is subject to continuing eligibility requirements. I understand that applicant institutions will be subject to review for compliance with applicable state and federal laws. Person completing this form: Printed Name: Title: The completed application and supporting documentation can be emailed to: Kristen Taft @ or mailed to the below address: Kristen Taft Workforce Development Services Division RI Department of Labor & Training 1511 Pontiac Ave Bld 73 FL 3 Cranston, RI 02920
1. Facility Name: Street Address: City, State, Zip: Special Notes/Comments: 2. Facility Name: Street Address: City, State, Zip: Special Notes/Comments: 3. Facility Name: Street Address: City, State, Zip: Special Notes/Comments: 4. Facility Name: Street Address: City, State, Zip: Special Notes/Comments: 5. Facility Name: Street Address: City, State, Zip: Special Notes/Comments: 6. Facility Name: Street Address: City, State, Zip: Special Notes/Comments: I certify that I am an authorized representative of the applicant institution seeking eligibility for the Eligible Training Provider List. I acknowledge that initial eligibility will be granted to each program for a 12-month period if approved. After the initial period of eligibility, each eligible program is subject to continuing eligibility requirements. I understand that applicant institutions will be subject to review for compliance with applicable state and federal laws. Person completing this form: Printed Name: Title: The completed application and supporting documentation can be emailed to: Kristen Taft @ or mailed to the below address: Kristen Taft Workforce Development Services Division RI Department of Labor & Training 1511 Pontiac Ave Bld 73 FL 3 Cranston, RI 02920