| Name of Grantee: |
| Grant No: |
| Reporting Period: |
| No. of participants enrolled and assisted to create a career development plan |
| Average income of enrolled participants |
| No. of participants enrolling in a career development activity (please categorize below) |
| Degree Program |
| Certification Program |
| Skills Training Program |
| Apprenticeship or On-the-Job Training Program |
| Work Readiness Training |
| ESL Training |
| Other (please describe) |
| No. of participants completing a career development activity (please categorize) |
| Degree Program |
| Certification Program |
| Skills Training Program |
| Apprenticeship or On-the-Job Training Program |
| Work Readiness Training |
| ESL Training |
| Other (please describe) |
| No. of participants obtaining new professional credential |
| No. of participants obtaining recognition of existing credential |
| No. of participants obtaining employment in a professional/skilled career field |
| Average income of participants who obtained employment |
|
| THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) |
|
| Public reporting burden for this collection of information is estimated to average 5 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. |