WORKFORCE DEVELOPMENT DIVISION DUAL ENROLLMENT AMENDED PART I 3. Dual Enrollment 1. Student Name 2. Social Security Number Adult 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 Allocation 7. Training (max104) 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 Number Representative Enrolling Approval: Signature of Authorized Representative: Submit amendments to WDD, P.O. Box 5690, Montgomery, AL 36103-5690, 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. Dual Enrollment Number 4. 5. Ending Beginning - Date: $ 6. Tuition Date: Per Semester Per Other@ 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-D Amended Rev. 1/2013
WORKFORCE DEVELOPMENT DIVISION DUAL ENROLLMENT AMENDED PART I 1. Student Name 2. Social Security Number 3. Dual Enrollment Adult 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 Number Enrolling Approval: Signature of Authorized Representative: * Submit amendments to WDD, P.O. Box 5690, Montgomery, AL 36103-5690, 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. Dual Enrollment 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-D Amended Rev. 1/2013
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