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A completed and signed California (CA) Eligible Training Provider (ETP) Assurance Form must be uploaded to the documents section of the Provider Profile in CalJOBS.

Part A.

I certify that the School listed on this application:

  1. Is a legal entity, registered to do business in the State of California (CA).
  2. Has not been determined to be ineligible to receive federal funds.
  3. Is in compliance with the Workforce Innovation and Opportunity Act Section 188 and title 29 Code of Federal Regulations Part 38.
  4. Has demonstrated effectiveness in operating occupational classroom or distance training program(s).
  5. Agrees that the training provider facilities, classroom instruction, relevant financial records, and attendance records may be reviewed by state, federal and/or local monitors or auditors to ensure compliance with funding requirements.


Part B.

I certify that I:

  1. Have reviewed the annual student data reporting requirements for the Eligible Training Provider Performance Report (ETP Report) established for training providers. Please refer to the ETP Report Required Data listed below.
  2. Will begin collecting required student data elements that are not currently being collected.
  3. Will report and submit the ETP Report data for all students trained in each of my school/organization’s training programs listed as approved on the Eligible Training Provide List (ETPL) to the Employment Development Department by the due date.

I understand that my school/organization’s application for program approval on the CA ETPL will not be processed without receiving this Eligible Training Provider Assurances Form.

By entering my name below, I acknowledge and affirm that the information I have provided in this form is true, accurate, and correct to the best of my knowledge and belief. I acknowledge that providing false or misleading information may lead to the rejection of this application and the potential disqualification from future application opportunities.

Name of School/Organization Representative
Required Data Fields
ETPL Provider Number
ETPL Program Number
Total Number of Individuals Served
Total Number of Individuals Exited
Total Number Who Completed the Program
Total Number Employed 2nd Quarter After Exit
Median Earnings in the 2nd Quarter After Exit
Total Number Employed 4th Quarter After Exit
Total Number of Individuals that Attained a Credential
Average Earnings in the 2nd Quarter After Exit
Average Earnings in the 4th Quarter After Exit