WORKFORCE DEVELOPMENT DIVISION INDIVIDUAL TRAINING ACCOUNT/INDIVIDUAL REFERRAL AMENDED PART I 3. ITA/IR Number 1. Student Name 2. Social Security Number Adult Youth Dis. Other Gov. Set. Wkr. Gov. 4. Education Training 5. 6. Curriculum Set. Location/Campus Provider Up to: A. Beginning 8. #of weeks 9. Cost 7. Training (max104) Allocation Date A. Original Schedule B. Ending Date 10. #of semesters 11. Category of B. Reenrollment Form 12. Item Numbers 13. Date of Change: Change: 14. Comments: Signature of Enrolling Agency Enrolling Agency Date Phone Number Representative Enrolling Approval: Signature of Authorized Representative: Submit amendments to WDD, P.O. Box 5690, Montgomery, AL for approval. * AMENDED PART II These budget items represent the training provider's official WIA budget for the student named above and is completed when student begins training. 2. Social Security Number 1. Student Name 3. ITA/IR Number 4. 5. Ending Beginning - Date: $ 6. Tuition Date: Per Semester Other@ Per 7. Fees, insurance, etc. (list items and cost) 8. Tools (list items and cost) 9. Other (list items and cost) - $ 10. Total If this is an amendment – Comments: Workforce Development Division Date Training Provider’s Authorized Date Representative Representative *Submit amendments to Part II to ITA Payment Unit for approval WDD-13 Amended Rev. 1/2013
WORKFORCE DEVELOPMENT DIVISION INDIVIDUAL TRAINING ACCOUNT/INDIVIDUAL REFERRAL AMENDED PART I 1. Student Name 2. Social Security Number 3. ITA/IR Number Adult Youth Dis. Wkr. Gov. Set. Gov. Set. Other 4. Education Training Provider 5. Location/Campus 6. Curriculum 7. Training Schedule A. Beginning Date 8. #of weeks (max104) 9. Cost Allocation Up to: B. Ending Date 10. #of semesters 11. Category of Form A. Original B. Reenrollment 12. Item Numbers Change: 13. Date of Change: 14. Comments: Signature of Enrolling Agency Representative Enrolling Agency Date Phone Number Enrolling Approval: Signature of Authorized Representative: * Submit amendments to WDD, P.O. Box 5690, Montgomery, AL for approval. AMENDED PART II These budget items represent the training provider's official WIA budget for the student named above and is completed when student begins training. 1. Student Name 2. Social Security Number 3. ITA/IR Number 4. Beginning Date: 5. Ending Date: 6. Tuition Per Semester $ - Other@ Per 7. Fees, insurance, etc. (list items and cost) 8. Tools (list items and cost) 9. Other (list items and cost) 10. Total $ - If this is an amendment – Comments: Workforce Development Division Representative Date Training Provider’s Authorized Representative Date *Submit amendments to Part II to ITA Payment Unit for approval WDD-13 Amended Rev. 1/2013