Form C "Student Data Certification Statement" - Louisiana

What Is Form C?

This is a legal form that was released by the Louisiana Workforce Commission - a government authority operating within Louisiana. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2018;
  • The latest edition provided by the Louisiana Workforce Commission;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form C by clicking the link below or browse more documents and templates provided by the Louisiana Workforce Commission.

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Download Form C "Student Data Certification Statement" - Louisiana

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APPENDIX 1: ELIGIBLE TRAINING PROVIDER FORMS
rd
1001 North 23
Street
225-342-7692
(O)
John Bel Edwards, Governor
Post Office Box 94094
225-342-7690
(F)
Ava Dejoie, Secretary
Baton Rouge, LA 70804-9094
www.laworks.net
Office of Workforce Development
STUDENT DATA CERTIFICATION STATEMENT
(Student data will not be processed by LWC prior to receipt of this Certification)
Office of Workforce Development
Email:
crs@lwc.la.gov
This data is being submitted on behalf
of:
NAME OF INSTITUTION
INSTITUTIONAL CODE
PROGRAM NAME
CIP CODE
For Program Year
Select
June 1,
through May 31,
# of Exiters
-----------------►
June 1,
through May 31,
-----------------►
# of Enrollees
I hereby certify that all Student Data provided is true and correct to the best of my knowledge. I understand that this
data will be used solely for the determination of eligibility for WIOA funding and for the state SCORECARD. I further
understand that there are administrative penalties for submitting false or inaccurate information in accordance to
section 122 of the Workforce Innovation and Opportunity Act of 2014.
Certification must be signed by an authorized authority (such as the CEO, President, Owner, Director of Admissions, etc.)
Signature
Printed Name
Title
Date
LWC USE ONLY
Date Received:
Completed By:
Date Completed:
Form C: Student Data Certification Statement
Page 1 of 1
07/18
APPENDIX 1: ELIGIBLE TRAINING PROVIDER FORMS
rd
1001 North 23
Street
225-342-7692
(O)
John Bel Edwards, Governor
Post Office Box 94094
225-342-7690
(F)
Ava Dejoie, Secretary
Baton Rouge, LA 70804-9094
www.laworks.net
Office of Workforce Development
STUDENT DATA CERTIFICATION STATEMENT
(Student data will not be processed by LWC prior to receipt of this Certification)
Office of Workforce Development
Email:
crs@lwc.la.gov
This data is being submitted on behalf
of:
NAME OF INSTITUTION
INSTITUTIONAL CODE
PROGRAM NAME
CIP CODE
For Program Year
Select
June 1,
through May 31,
# of Exiters
-----------------►
June 1,
through May 31,
-----------------►
# of Enrollees
I hereby certify that all Student Data provided is true and correct to the best of my knowledge. I understand that this
data will be used solely for the determination of eligibility for WIOA funding and for the state SCORECARD. I further
understand that there are administrative penalties for submitting false or inaccurate information in accordance to
section 122 of the Workforce Innovation and Opportunity Act of 2014.
Certification must be signed by an authorized authority (such as the CEO, President, Owner, Director of Admissions, etc.)
Signature
Printed Name
Title
Date
LWC USE ONLY
Date Received:
Completed By:
Date Completed:
Form C: Student Data Certification Statement
Page 1 of 1
07/18