IWTP APPLICATION EVALUATION RATING FORM(Sample)
          Employer:                                                               Date:                  Level 2 Subtotal:      0
          NAICS:                                                                                         Level 3 Subtotal:      0
          Training Provider:                                                                             Level 4 Subtotal:      0
          Total Funding Requested:                                                                       Grand Total:           0
          Field Specialist:                                                       Region:
          Purpose:                           Wage Increase              Update Job Skills             Create Jobs             Retention
                                                                Eligibility Criteria
                                                                                                                               Yes     No
          The application is responsive to at least one of the following qualifying categories:
               An individual employer or a consortium made up of two or more eligible employers that meet all of the 
               following requirements: operating in the State of Louisiana for a minimum of three (3)
               years, contributing to the Incumbent Worker Training Account and in full compliance with
               Louisiana Unemployment Insurance Laws. 
               Is a labor or community-based organization, or a consortium made up of any combination of
               educational institutions, eligible individual employers, or labor or community-based
               organizations, that seek to provide customized or preemployment training for workers who meet
               all of the following:
                   (a) Are in a demand occupation.
                   (b) Are incumbent to an industry.
                   (c) Were attached to a contributing employer within the last twelve months.
                   (d) Are not receiving unemployment insurance benefits at the time of training. 
          The application demonstrates the statutory Requirement for eligibility:
               The applicant agrees to one of the following statutory requirements:
                   (a) Increase the wages of those persons who complete the training finded woth such monies.
                   (b) Create new jobs.
                   (c) Give preference to those currently unemployed when hiring new employees.
                   (d) Provide an in-kind match as a component of the training program.
                                       Level 1: Demand/Cost Effectiveness/Prior Performance
                                                                                                                               Yes     No
            1
               Are the occupations to be trained ranked as "Labor Demand Occupations" (Demand Level 1 or 2
               on the 2008-2018 Long Term Demand List or locally determined occupations in demand as 
               determined by the Local Workforce Development Board (WDB)? If non-demand occupations are
               listed for training, does the application demonstrate that the training of employees in
               non-demand occupations is necessary to prevent the likely loss of jobs?
            2  Are training costs consistent with IWTP Training Costs Database or justified?
            3                                                                                                          N/A
               If reapplying, did performance on last grant meet or exceed 75% of
               performance objectives?
            4
               If performance on last grant did not meet 75%, has one year elapsed since the end date of the
               prior contract?
                                  Level 2: Considerations from IWTP Rules (LAC 40:XVI.101 - 113)
                                                                                                          Maximum Points Actual Points
                                                                                                              Allowed           Awarded
            1  Selected a public training provider as the primary training provider                              20                 0
            2  Never received a training award under this program.                                               20                 0
            3  Listed a job opening(s) with HiRE within the last 12 months                                       20                 0
                              J.O. #                      Date
            4
                Submitting an application that includes employer donations for materials,
                equipment, or instruction to a public training provider(> 0 - 5% of total funding
                requested listed in donations to a public provider = 5 points; >5 - 10% of total
                funding requested listed in donations to a public provider = 10 points; >10% of
                total funding requested listed in donations to a public provider = 15 points).                     15                 0
                                                   Instruction/Course                                                WIA
                                                   Equipment, Furniture & Classroom Fixtures                         UI
                                                   Materials & Supplies                                              FTAP
                 $                                                     -    TOTAL Contributions to Public Providers  Rehabilitative
                 $                                                     -    Total Funding Requested                  Other
                                                  - Contributions to Public Providers as a Percent of Total Funding Requested
            5
                Participated in a Workplace Safety Consultation with employees of the Office of 
                Workers' Compensation Administration within the last 12 months (contact 
                WorkplaceSafety@lwc.la.gov for details)                                                            15                 0
                     Date:
            6   Hired recipients of public assistance such as WIOA, UI, FITAP, or Rehabilitative Services 
                within the last 12 months                                                                          15                 0
                              Name                 Date of Assisstance          Type of Assistance
            7   Hired individuals released from a correctional facility within the last 12 months                  15                 0
                              Name                   Date of Release             Name of Facility
                                                                                               SUB TOTAL          120                 0
                                                     Level 3: Additional Considerations
                                                                                                           Maximum Points Actual Points
                                                                                                                Allowed           Awarded
            1
                Average Employee Advancement/Wage Increase (the average wage increase
                for those persons for whom a wage increase was the intended outcome) (1
                point per % of average wage increase listed on application under “Scope of
                Training Requested”, Maximum 20%).                                                                 20                 0
                                       % Projected Average Wage Increase
            2
                Create Additional Jobs (the number of positions created and filled as a result of
                employees who participate in IWTP training and are subsequently promoted to
                higher level positions) (> 0 - 5% of total employees to be trained listed as
                additional jobs created = 10 points; >5 -10% of employees to be trained listed as 
                additional jobs created = 15 points; >10% or more of employees to be trained as 
                additional jobs created = 25 points).                                                              25                 0
                                       Number of Employees To Be Trained
                                       Number of Additional Jobs To Be Created
                                      - % of Additional Jobs To Be Created
            3
                Job Retention (Jobs retained defined as prevention of job loss caused by obsolete skills, 
                technological change, or national or global competition.) (ALL employees trained using 
                IWTP funds will be retained as a result of training = 20 points; majority of employees 
                trained using IWTP funds will be retained as a result of training = 10 points).                    20                 0
            4
                Average cost per student ($500 or less average cost per participant = 25 points; $501 - 
                $1000 average cost per participant = 20 points; $1001 - $1500 average cost per 
                participant = 15 points; $1501 - $2000 average cost per participant = 10 points).                  25                 0
                 $                                -    Total Funding Requested
                                       Total To Be Trained
                                      -  Average Cost Per Participant
           5
               Attendance Incentive (Employer allows ALL training to occur during work hours
               or pay wages for ALL training after hours = 20 points; allows majority of training
               to occur during work hours or pay wages for majority of training after hours = 10
               points).                                                                                       20                 0
           6   Has an approved apprenticeship or as hired an apprentice from a Louisiana Registered 
               Aprenticeship Program within the last 12 months.                                               15                 0
           7
               Application submitted with other eligible employer contributions not included
               in Level 2, Item 4 (> 0 - 5% of total funding requested in other eligible
               donations = 5 points; >5% - 10% of total funding requested in other eligible
               donations = 10 points; >10% or more of total funding requested in other eligible
               donations = 15 points).                                                                        15                 0
                                      Private/Vendor Courses
                                      Use of Equipment/Furniture/Classroom Fixtures
                                      Travel
                                      Administrative Costs
                                      Materials & Supplies
                                      Facility Rental/Use of
                                      Other
                $                                -    Total
                                    - of Total Funding Requested
                                                                                           SUB TOTAL          140                0
                                                   Level 4: Reapplying Considerations
                                                                                                       Maximum Points Actual Points
                                                                                                           Allowed           Awarded
           1   Employer Expansion (Additional Sites or Workers, Physical Expansion, New
               Processes or Product Lines).                                                                    5                 0
               Describe:
           2   Met 85% or exceeded Performance Objectives on prior contract.                                   5                 0
                                                                                           SUB TOTAL          10                 0
                                                                                                       Maximum Points Actual Points
                                                                                                           Allowed           Awarded
                                                                                   LEVEL 2 SUB TOTAL          120                0
                                                                                   LEVEL 3 SUB TOTAL          140                0
                                                                                   LEVEL 4 SUB TOTAL          10                 0
         Last updated: 10/3/2018                                                        GRAND TOTAL           270                0