RI GWB NonTrad Apprentice

Non-Traditional Apprenticeship Incentive Application
Employer Information

The Non-Traditional Apprenticeship Incentive Program will provide an incentive of $1,000 per non-trade apprentice registered subsequent to January 1, 2016 and after the completion of the required probationary period. Employers shall be eligible for up to $5,000 in monetary incentive within any 12 month period.

NOTE: Non-trade apprenticeships are apprenticeships that are registered with the Department of Labor and Training that are outside of the construction trades. The required probationary period is a standard that established as part of the apprenticeship approval process and will vary based on the apprenticeship model.

The employer must submit a completed approval form and signed federal W-9 form (for the employer). Funds will not be awarded for any non-trade apprentice that has not completed the required probationary period.
Employer Name:*
Employer NAICS Code:*
If not sure, visit: www.naics.com/search/
Employer Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Person*

First NameLast Name
Contact Person Job Title*
Phone Number*

Area CodePhone Number
Contact Person Email*
NAME of Apprenticeship Program*
APPRENTICE INFORMATION
Apprentice Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
Date of Birth

MonthDayYear
Apprentice Gender (Optional)

MaleFemale
Apprentice Age (Optional)

18-24 Years old25-54 Years old55+ Years old
Apprentice Race/Ethnicity

American Indian or Alaskan NativeAsianBlack or African AmericanNative Hawaiian or Pacific IslanderWhiteHispanic/LatinoOther/Multiracial
Upload a Signed Copy of W9 Tax Form*

Upload a File
https://www.irs.gov/pub/irs-pdf/fw9.pdf Cancelof
Employer Attestations and Signature
My organization is registered as an approved RI state supplier in the Ocean State Procures 'OSP' system.*
Please Initial
My organization is current on all Rhode Island tax obligations, is in good standing with all divisions and programs administered by the Department of Labor and Training, and has not been debarred (prohibited) from contracting with an agency that administers federal funds.*
Please Initial
I certify that my organization has not received any prior non-traditional apprenticeship incentives for the employee(s) listed in this application.*
Please Initial
Name of Person Completing Application *

First NameLast Name
Job Title*
The person above must be an individual with authority to enter into legally binding agreements on behalf of the applicant.

By signing below, I attest that the information contained in this application is correct and accurate to the best of my knowledge.
Signature*

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Non-Traditional Apprenticeship Incentive Application

Employer Attestations and Signature