ETP Student Enrollment Agreement  

Student Name:_____________________________________________________

Title:____________________________________________________________ 

Employer: ________________________________________________________

Email Address:_____________________________________________________

Daytime Phone: ____________________  Home Phone:_____________________

Home Address: ____________________________________________________

City:____________________ State:_________   Zip:____________________

 I, ____________________________, from __________________________ 

hereby agree to enroll in and complete ______ hours of training at BAVC within four months of my first day of class. In return for receipt of the training to be provided, I agree to attend all courses and lab time as scheduled, and to comply with the terms and conditions stated below:

·        This contract is non-transferable.  

 ·        My ETP training hours, once determined, cannot be decreased.  If I choose to continue my training beyond the hours agreed upon, my Employer is responsible for payment.

 ·        I must comply with all of BAVC’s practices and policies as stated in its workshop calendar and/or Student Handbook.

 ·        If I am absent from any of my scheduled hours, my absence must be based on good cause, and constitute no more than 20 percent of my total scheduled enrollment. I understand that my Employer will be held responsible for payment should I default on this Agreement. 

 ·        I will fax an Add/Drop Form two weeks in advance to drop and/or reschedule a class or my absence will be considered unexcused.

 I understand the following:

 ·        In order to qualify for this program, I must be a full-time, permanent employee with the ETP approved employer and earn equal to or more than $12.22 per hour (including benefits).

 ·        In order to participate in training I must either be working for the ETP approved employer for 90 days prior to starting training or receive a waiver from ETP prior to starting training.

 ·        My social security number will be used to track my enrollment and all participation in this ETP-funded program.

 ·        I may participate in an ETP-funded retraining program at only one institution at a time. I will not enroll in ETP training at more than one training facility simultaneously.

 ·        My company will incur the cost of my training should I not complete the assigned training hours or if I should leave the company within 90 days of completing my training.

 ·        My signature on the course attendance roster is the only means BAVC has to verify my completion of that course. I agree to sign the attendance roster during every course I attend. 

 ·        I agree to assist my employer in providing BAVC with a photocopy of my paycheck stub at the end of the 90-day retention period.

 ·        If I leave my current employer I am required to contact BAVC immediately. If I knowingly continue to take classes after leaving my current employer, I will be held liable for the training expenses I incurred.

  I agree to all of the terms and conditions as stated above.

_______________________________                   
Print Name                                                      

_______________________________                    __________________
Signature                                                                      Date

Please complete the following information required by the State of California of all participants. All information is confidential and is used solely for the purpose of reporting enrollment statistics to the California Employment Training Panel.

   (Please note: you must be employed with your current employer for 90 days or receive a waiver from ETP before you are eligible to participate.)


Print Name: First
 ____________ Middle Initial _____ Last ____________________

 Date Hired     _____________                                            

Text Box: Education	() Eighth Grade or Less
		() Some High School 
() High School Graduate		() GED
		() Some College
		() College Graduate				() Post-College Graduate
Text Box: Ethnicity	() White				() Black/African-American		() Latino/Hispanic
		() Asian/Asian-American		() Native American	
		() Pacific Islander			() Filipino
	() Other

Sex                  () Male  () Female       Disabled         () Yes         () No 

Married          () Yes    () No             Veteran           () Yes        () No

Public Aid Recipient      () Yes       () No     
 

Hourly Wage or Yearly Salary _________________________                                                                                      
Home Zip Code _________________         Birth date ________________

Social Security Number   _________________________

      For BAVC Use:

      BAVC Training  Start Date   _________   Job Number_____________  

     CA Employer ID ____________________________________