ETA-9134 High Growth and Community-Based Job Training Grants

Form ETA-9134

QUARTERLY PERFORMANCE REPORT HIGH GROWTH and COMMUNITY-BASED JOB TRAINING INITIATIVES

OMB No.

1205-0NEW

Expires:

mm/dd/yyyy

A. GRANTEE IDENTIFYING INFORMATION

1. Grantee Name:

2. Grant Number:

3. Program/Project Name:

4. Grantee Address:

5. Report Quarter End Date:

City ________________________________

State ______

Zip Code __________

6. Report Due Date:

Performance Items

Previous Quarter (A)

Current Quarter (B)

Cumulative Grant-to-Date (C)

B. CUSTOMER SUMMARY INFORMATION

1. Total Exiters

2. Total Participants Served

3. New Participants Served

Gender

3a. Male

3b Female

Ethnicity / Race

3c. Hispanic/Latino

3d. American Indian or Alaska Native

3e. Asian

3f. Black or African American

3g. Native Hawaiian or Other Pacific Islander

3h. White

3i. More Than One Race

3j. Hispanic/Latino and More Than One Race

3k. Eligible Veterans

3l. Persons with a Disability

C. CUSTOMER SERVICES AND ACTIVITIES

1. Number Began Education/Job Training Activities

2. Number Completed Education/Job Training Activities

2a. Number Received Degree/Certificate

2b. Number Entered Employment

2c. Number Entered Training-Related Employment

Industry Code

(1) NAICS Sector 11 - Agriculture, Forestry, Fishing & Hunting

(2) NAICS Sector 21 - Mining (including Oil and Gas Exploration)

(3) NAICS Sector 22 - Utilities

(4) NAICS Sector 23 - Construction

(5) NAICS Sectors 31-33 -- Manufacturing

(6) NAICS Sector 42 - Wholesale Trade

(7) NAICS Sectors 44-45 -- Retail Trade

(8) NAICS Sectors 48-49 -- Transportation & Warehousing

(9) NAICS Sectors 51 - Information

(10) NAICS Sector 52 - Finance & Insurance

(11) NAICS Sector 53 - Real Estate Rental & Leasing

(12) NAICS Sector 54 - Professional, Scientific, and Technical Services

(13) NAICS Sector 55 - Management of Companies & Enterprises

(14) NAICS Sector 56 - Administrative & Support and Waste Management & Remediation Services

(15) NAICS Sector 61 - Educational Services

(16) NAICS Sector 62 - Health Care & Social Assistance

(17) NAICS Sector 71 - Arts, Entertainment, and Recreation

(18) NAICS Sector 72 - Accommodation and Food Services

(19)NAICS Sector 81 - Other Services (except Public Administration)

(20) NAICS Sector 92 - Public Administration

D. REPORT CERTIFICATION/ADDITIONAL COMMENTS

1. Report Comments/Narrative:

Attach a separate document that provides a discussion of the grant narrative items outlined in the reporting instructions found under

Section D.1 in "High Growth and Community-Based Job Training Grants: General Quarterly Reporting Forms and Instructions." .

2. Name of Grantee Certifying Official/Title:

3. Telephone Number:

4. Email Address:

Persons are not required to respond unless this form displays a currently valid OMB number. Obligation to respond is required to obtain or retain benefits (Workforce Investment Act [Section 185(a)(2)]. Public reporting burden for this collection of information, which is to assist with planning and program management and to meet Congressional and statutory requirements, averages 28 hours per response, including time to review instructions, search existing data sources, gather and maintain the data needed, and complete and review the collection of information. Send comments regarding this burden estimate to the U.S. Department of Labor, ETA, Room N-4643, 200 Constitution Avenue, NW, Washington, DC 20210.