NHADA Training Grant - Dealer Authorization to School
Name
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Date
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Job Title
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Company Name
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List your company billing contact person
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Email
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example@example.com
Address
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Street Address
Street Address Line 2
City
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Zip Code
Phone
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Federal Tax ID
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I am authorizing CCSNH to invoice our company directly for tuition of our following employee(s) The registration form(s)accompanies this authorization form. If registering students for more than one college, please use a form for each school. Each student: By signing where indicated, you are authorizing the release of your records that relate to these courses from the college(s) to NHADA and your company, so that we may request confirmation from college instructors and billing offices, and authorize the direct bill to your employer (please check CCSNH school employee(s) attend).
Please select a school
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Great Bay Community College (GBCC) - Program Coordinator Paul Giuliano (pgiuliano@ccsnh.edu)
Lakes Region Community College (LRCC) - Department Chair Jamie Decato (jdecato@ccsnh.edu)
Manchester Community College (MCC) - Department Head Marc Bellerose (mbellerose@ccsnh.edu)
Nashua Community College (NCC) - Department Chair Karl Wunderlich (kwunderlich@ccsnh.edu)
White Mountain Community College (WMCC) - Department Head Troy Lachance (tlachance@ccsnh.edu)
Please list the employee you would like to train. Note: If you are training more than one employee, you must submit a form for each employee.
Employee Name
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Verification
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I verify that the above-named company is a member in good standing with NHADA.
I verify that the above-named company is based in New Hampshire and pays NH quarterly payroll taxes
I verify that the registrants(s) listed above are paid employees at the above-named place of business
I verify that the tuition/books will be paid by the company and that the employee(s) may not be charged
With my signature, I authorize CCSNH to provide a copy of this form to the New Hampshire Automobile Dealers Association (foundation@nhada.com) and notification of successful completion of the courses, which will facilitate reimbursement of half the tuition to NHADA members.
Signature
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