ETA-9134 HG CB QUarterly Performance Report

Form ETA-9134
QUARTERLY PERFORMANCE REPORT
HIGH GROWTH and COMMUNITY-BASED JOB TRAINING GRANTS
OMB No.
Expires:

1205-0465
5/31/2011

A. GRANTEE IDENTIFYING INFORMATION
1. Grantee Name:

2. Grant Number:

3. Program/Project Name:
4. Grantee Address:

5. Report Quarter End Date:

City ________________________

State ______

Performance Items

Zip Code __________
Previous
Quarter
(A)

6. Report Due Date:
Current
Quarter
(B)

Cumulative
Grant-to-Date
(C)

B. PARTICIPANT SUMMARY INFORMATION
1. Total Exiters
2. Total Participants Served

Gender

3. New Participants Served
3a.i Male
3a.ii Female
3b. Hispanic/Latino

Ethnicity / Race

3c.i American Indian or Alaska Native
3c.ii Asian
3c.iii Black or African American
3c.iv Native Hawaiian or Other Pacific Islander
3c.v White
3c.vi More Than One Race
3c.vii Hispanic/Latino and More Than One Race
3d. Eligible Veterans
3e. Persons with a Disability

C. PARTICIPANT SERVICES AND ACTIVITIES
1. Number Began Education/Job Training Activities
2. Number Completed Education/Job Training Activities
2a. Number Received Credential

C.2a (1)-(5) and C.2b):
These specific data
elements apply only to
grants awarded under the
CBJTG Round 5 SGA:
SGA/DFA PY-09-07.

(1) Certificate
(2) Associate's Degree
(3) Bachelor's Degree
(4) Other Degree
(5) Other Credential
2b. Total Credentials Received
2c. Number Entered Employment
2c.i Number Entered Training-Related Employment
(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
Industry Code

(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

C.2c.ii: This specific
data element applies
only to grants
awarded under the
CBJTG Round 5 SGA:
SGA/DFA PY-09-07

2c.ii Employment Retention

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 un
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.

Page 1 of 1