ETA-9160 TAACCCT Annual Performance Report

Form ETA-9160
ROUNDS 2, 3 AND 4 ANNUAL PERFORMANCE REPORT
TAA COMMUNITY COLLEGE and CAREER TRAINING GRANTS
OMB No. 1205-0489
Expires: 07/31/2018

A. GRANTEE IDENTIFYING INFORMATION
1. Grantee Name:

2. Grant Number:

3. Program/Project Name:
5. Report Year End
Date:

4. Grantee Address:
City ____________________________________________________________________________________

State ______
Year 1
(A)

Performance Items

Year 2
(B)

Zip Code __________
Year 3
(C)

6. Report Due Date:
Year 4
(D)

(REPORT IF AVAILABLE)

B. ANNUAL PARTICIPANT OUTCOMES (ALL GRANT PARTICIPANTS)
1. Unique Participants Enrolled
2. Total Number of Participants Who Have Completed a Grant-Funded Program of Study
2a. Total Number of Grant-Funded Program of Study Completers Who Are Incumbent Workers

3. Total Number of Participants Still Retained in Their Programs of Study (or Other Grant-Funded
Programs)
4. Total Number of Participants Retained in Other Education Program(s)
5. Total Number of Grant-Funded Credit Hours Completed
5a. Total Number of Participants Completing Credit Hours

6. Total Number of Earned Certificates/Degrees
6a. Total Number of Participants Earning Certificates - Less Than One Year
6b. Total Number of Participants Earning Certificates - More Than One Year
6c. Total Number of Participants Earning Degrees

7. Total Number of Participants Enrolled in Further Education After Program of Study Completion and
Exit
8. Total Number of Participants Employed After Program of Study Completion and Exit
9. Total Number of Participants Retained in Employment After Program of Study Completion and Exit
10. Total Number of Participants Employed at Enrollment Who Receive a Wage Increase PostEnrollment

C. ANNUAL PARTICIPANT SUMMARY INFORMATION (ALL GRANT PARTICIPANTS)
Gender

1a. Male
1b. Female
2a. Hispanic/Latino

Ethnicity / Race

2b. American Indian or Alaskan Native
2c. Asian
2d. Black or African American
2e. Native Hawaiian or Other Pacific Islander
2f. White
2g. More Than One Race
Degree

3a. Full-time Status
3b. Part-time Status

Other Demographics

4. Incumbent Workers
5. Eligible Veterans
6. Participant Age (Mean)
7. Persons with a Disability
8. Pell-Grant Eligible
9. TAA Eligible
10. Other Demographic Measure (Optional - Entered by Applicant)

D. ACHIEVEMENTS AND SUCCESSES
1. Summarize your most innovative achievement or your greatest success story from the previous year.
Please limit your response to 700 characters.

F. SERVICES and OUTCOMES for TAA ELIGIBLE INDIVIDUALS
1. Provide a description of how the program(s) have served TAA eligible individuals. Specifically, address: 1) the number of TAA Eligible individuals who participated in TAACCCT
funded programs, 2) how many TAA Eligible individuals enrolled and obtained credentials, certificates or degrees, 3) how many TAA Eligible Individuals enrolled and did not attain
credentials, certificates or degrees, and 4) the average duration and whether the duration of education and training was longer or shorter for these individuals than for other nonTAA eligible participants (provided in weeks). You may use observations or participant records to compile and summarize this information.
Please limit your response to 700 characters.

G. REPORT CERTIFICATION/ADDITIONAL COMMENTS
1. Report Comments/Narrative:

Please describe any additional outcomes or information about your grant.

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 48 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.

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