UI / DE 3100TP

SAMPLE, this page for reference only

EDD Employment Development Department State of California Logo

EDD Phone Numbers:
English:
1-800-300-5616
Spanish:
1-800-326-8937
Mandarin:
1-866-303-0706
Vietnamese:
1-800-547-2058
Cantonese:
1-800-547-3506
TTY (non-voice):
1-800-815-9387

TRAINING PROVIDER QUESTIONNAIRE

Applicant Name:
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APPLICANT INSTRUCTIONS

You must have your training provider, authorizing program, or union representative complete this questionnaire as proof of your enrollment and validation of the information you provided on the California Training Benefits (CTB) Application, DE 3100TQ. To be considered for the CTB program, you must complete and return BOTH the application and this questionnaire within ten (10) calendar days of the mail date of this notice to the Employment Development Department (EDD) as instructed in the California Training Benefits (CTB) Program Information and Application, DE 3100T.
Provide the enclosed Training Provider Letter, DE 3100D, to your training provider to authorize the release of your school or training information to the EDD. Do not return the Training Provider Letter to the EDD. Your training provider must keep the Training Provider Letter for their records.

TRAINING PROVIDER, TRAINING PROGRAM, OR UNION REPRESENTATIVE INSTRUCTIONS

Please complete this questionnaire for the applicant named above and return the completed and signed form to the applicant. The term “training program” refers to both vocational training programs and degree programs. The information you provide will be used to validate the training information provided to the EDD by the applicant. The information is also used to determine the applicant's eligibility to receive unemployment insurance (UI) benefits under the California Training Benefits (CTB) program while attending training.

SECTION A - SCHOOL OR TRAINING PROGRAM

  1. What is the applicant’s training program or course of study?
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  2. Is the applicant’s training provider and specific training program listed on California’s Eligible Training Provider List (ETPL)?
  3. What industry related license, credential, or certification will the applicant receive after completing the training program, if any?
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  4. What type of work or specific occupation will the applicant be qualified to perform after completing the training program?
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  5. What date did the applicant first begin attending the training program?
    MM/DD/YYYY
  6. What date is the applicant expected to complete the entire training program, including any intern/externships?
    MM/DD/YYYY
  7. Is the applicant’s school or training attendance considered full-time?
  8. Does the training program offer a summer session or classes during the months of June, July, and/or August?
    1. Will the applicant attend the next summer session?
    2. What are start and end dates of the next summer recess?
      MM/DD/YYYY to MM/DD/YYYY
  9. What are the start and end dates of any scheduled recess periods, breaks, or summer recesses that will occur during the applicant’s school or training attendance? (A school calendar may also be provided.)
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  10. What are the start and end dates of any semesters or quarters that will occur during the applicant’s school or training attendance? (A school calendar may also be provided.)
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DE 3100TP Rev. 1 (10-15)

SAMPLE, this page for reference only

EDD Employment Development Department State of California Logo

 

TRAINING PROVIDER QUESTIONNAIRE

Applicant Name:
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SECTION B - DISCRETIONARY FUNDS

Applicants who are receiving discretionary funds paid by a training provider cannot be approved for the CTB program and may not be eligible to receive UI benefits. Discretionary funds are defined as cash-in-hand payments, not including payments for tuition, books, supplies, or transportation. If the applicant is receiving discretionary funds, he or she must waive the receipt of discretionary funds in order to be eligible for the CTB program. If the applicant is receiving discretionary funds, please answer questions 1 and 2 below:
  1. What is the amount and purpose of the discretionary funds?
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  2. Has the applicant waived receipt of the discretionary funds?

SECTION C - TRAINING INFORMATION CERTIFICATION

Name of the applicant’s school or training institution:
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School or training institution location: (If attending multiple locations, provide the primary location.)
Street Address:
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City:
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County
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State
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Zip
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Name of the entity that accredited your school or training institution:
(As listed on the U.S. Department of Education’s database.)
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By signing below you agree to the following statement: I certify the information I provided on this form concerning the training enrollment of the student named above is true and correct.
Authorized
Representative Signature:
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Date Signed
MM/DD/YYYY
Authorized
Representative Name (Printed):
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Authorized
Representative Title:
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Phone
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SECTION D - AUTHORIZING PROGRAM INFORMATION

If the applicant’s school or training program is authorized, sponsored, or funded by one of the following programs or sources, check the appropriate box below and provide the program information and an authorized program representative’s contact information for verification purposes.
Is the applicant an active journey or master-level union/association member?
Authorized
Representative’s Name:
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Phone
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Name of Organization:
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Phone
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Address:
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City
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State
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Zip
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EDD Contact Information
If you have any questions about this questionnaire, the CTB program, or if you need to make any corrections to the information you have supplied, you can contact the EDD by going online to the EDD website at www.edd.ca.gov and selecting the “Contact EDD” tab or by calling the toll-free number at ‎1-800-300-5616.
 

Form Tracking:Blank space

DE 3100TP Rev. 1 (10-15)