RTIG Training Application

RTIG Training Application
UPDATED REQUIREMENTS

As of March 24, 2023 we are only accepting applicants of individuals living in Clare, Gladwin, Arenac, Isabella, Bay, Gratiot and Saginaw counties with an annual income of $36,150. Those in Midland county must be at $42,850 or lower.
Before You Begin!!!

Please have the following available before you complete this form.
- Your 2021 tax document (if you did not file taxes, you will be asked to complete an "Affidavit with Respect to Taxable Income" form as part of this application)
- Photos of the front and back of your Driver's License of Michigan ID OR you are able to capture these photos using your phone as you complete this form
- Paystubs for the last 2 months OR your 2022 W2
Applicant Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you related to an employee or official of Middle Michigan Development Corporation, Delta College, and/or Mid Michigan College?*

YesNo
Please explain your relationship to someone employed by one of the above institutions...
Are you currently employed?*

YesNo
Are you applying for training through an employer?

YesNo
What is the name of the company you work for
In what county is your employer located?

Arenac CountyBay CountyClare CountyGladwin CountyGratiot CountyIsabella CountyMidland CountySaginaw CountyOther
Which college is your employer working with to provide trainings?

Delta CollegeMid Michigan CollegeI don't know
Are you employed full time or part time?

Full TimePart Time
How many hours a week do you work on average?
What county do you live in?*

Arenac CountyBay CountyClare CountyGladwin CountyGratiot CountyIsabella CountyMidland CountySaginaw CountyOther
County for comparison
Impact(s) of COVID. Please select AT LEAST one of the following ways that you were impacted by COVID-19. You may select more than one.*

Being laid off because of COVID-19Reduction in my work hours and pay due to COVID-19Needing to take extended time off work due to COVID-19 to care for my child/children whose school was closedNeeding to take extended time off work due to COVID-19 to care for a family member who was or is sick with COVID-19Needing to take extended time off work because I tested positive for COVID-19Needing to take extended time off work to seek medical care to confirm that I had COVID-19Incurred additional costs directly related to preparing, preventing, or responding to the COVID-19 pandemicOther
Estimated date when hardship above started*

MonthDayYear
Date must be later than March 1, 2020
What racial and ethnic identity do you identify with?*

WhiteAsianBlack / African AmericanAmerican Indian / Alaskan NativeNative Hawaiian / Other Pacific IslanderAsian and WhiteAmerican Indian / Alaskan Native and WhiteAmerican Indian / Alaskan Native and BlackBlack / African American and WhiteOther Multi-Racial
Are you of Hispanic / Latino Descent?*

YesNo

Please list your sources of income for 2021 and your annual earnings for each*

	Source of Income	Annual Income from Source
1
2
3
4
5

Total Annual Income (Auto-Calculated)
Did you file a Federal Tax Return in 2021?*

YesNo
Affidavit with Respect to Taxable Income

Because you indicated that you did not complete a tax filing in 2021, you will need to complete the below questions in order to be eligible for this training program.
Date of Birth

MonthDayYear
Date
Social Security Number
I declare that I did not file an Internal Revenue Service Form 1040 for the 2021 calendar year for the income reported on this form.
WARNING: Penalty for false or fraudulent statement: The information provided on this form is subject to verification by HUD at any time, and Title 18, Section 1001 of the US Code states that a person is guilty of a felony and assistance can be terminated for knowingly and willingly making a false or fraudulent statement to a department of the United States.
Signature that the above responses in section "Affidavit with Respect to Annual Income" are true to the best of my understanding.

Clear
Date

MonthDayYear
Date
LMI Categorization
Please select all trainings you would like to take part in.*

Blue Print ReadingShop MathBasic ElectricalCore ToolsProject Management Fundamentals5SCNC ProgrammingGeometric Dimensioning and Tolerancing FundamentalsTotal Productive Maintenance (TPM)Lean A3 and Problem SolvingRSLogix 5000 PLC BasicsFluid PowerStatistical Process Control with MSAOSHA 10OSHA 30Fanuc Robotics Material Handling Basic Programming and operationsFanuc Robotics Advanced Irvision Programming and OperationsSupervisory Skills: Conflict ResolutionSupervisory Skills: Leadership for First-Line SupervisorsMicrosoft Excel 2016 Level 1Electrical Overview & SchematicsHigh Performing LeadershipLEAN ManufacturingPLC Overview, Troubleshooting & ProgrammingProject ManagementRobotics Theory, Operations & ProgrammingSafety- Confined Space EntrySafety- Hand and Power ToolSafety- HAZWOPERSafety- HAZWOPER RefresherSales Acceleration and Account ManagementSupervisory Skills: Principles of SupervisionSupervisory Skills II: Personal Effectiveness
Do you have a preference for which college provides training to you?

Yes - Delta CollegeYes - Mid Michigan CollegeNo preference
Signature*

Clear
I verify that I am the person whose name and signature appears on this form, and I have reported this information as accurately as possible.*

YesNo
Home Michigan Works!
Would you like to upload the front and back image of your driver's license or State Identification Card or, if you are on mobile, take photos of these?*

I'll upload photosI'd like to use my camera to take photos now
Please take a photo of the FRONT of your Driver's License or State Identification Card
Please take a photo of the BACK of your Driver's License or State Identification Card
Please upload the following items to complete your application: 1. Your federal tax document from 2021 (pages 1 & 2 of your 1040 form); 2. Photos of the front and back of your driver's license or State-issued ID (if you didn't already take photos of it); 3. Your last two months of paystubs OR a 2022 W2.

Cancelof
Review your application for completeness.
Have you provided us with a photo of your Drivers License or State Identification Card, FRONT and BACK?*

YesNo
Have you provided us your 2021 federal tax document or did you complete the "Affidavit with Respect to Taxable Income" portion of this application?*

YesNo
Have you provided us with your last two months of paystubs OR a 2022 W2?*

YesNo. My employer is going to send to MMDC.I didn't upload and my employer is not planning to send to MMDC.
Administrative Use
Identified College Partner
Self-Reported Application Completeness (Numeric)
Self-Reported Application Completeness
Follow Up Needed
Application Complete?

YesNo
Missing Documentation

Drivers LicenseTax FormPay Stubs or 2022 W2Other
College Use
Training Provided by

Delta CollegeMid Michigan College
Trainings Attempted

Blue Print ReadingShop MathBasic ElectricalCore ToolsProject Management Fundamentals5SCNC ProgrammingGeometric Dimensioning and Tolerancing FundamentalsTotal Productive Maintenance (TPM)Lean A3 and Problem SolvingRSLogix 5000 PLC BasicsFluid PowerStatistical Process Control with MSAOSHA 10OSHA 30Fanuc Robotics Material Handling Basic Programming and operationsFanuc Robotics Advanced Irvision Programming and OperationsSupervisory Skills: Conflict ResolutionSupervisory Skills: Leadership for First-Line SupervisorsMicrosoft Excel 2016 Level 1Electrical Overview & SchematicsHigh Performing LeadershipLEAN ManufacturingPLC Overview, Troubleshooting & ProgrammingProject ManagementRobotics Theory, Operations & ProgrammingSafety- Confined Space EntrySafety- HAZWOPERSafety- HAZWOPER RefresherOther
Credential Earned

Blue Print ReadingShop MathBasic ElectricalCore ToolsProject Management Fundamentals5SCNC ProgrammingGeometric Dimensioning and Tolerancing FundamentalsTotal Productive Maintenance (TPM)Lean A3 and Problem SolvingRSLogix 5000 PLC BasicsFluid PowerStatistical Process Control with MSAOSHA 10OSHA 30Fanuc Robotics Material Handling Basic Programming and operationsFanuc Robotics Advanced Irvision Programming and OperationsSupervisory Skills: Conflict ResolutionSupervisory Skills: Leadership for First-Line SupervisorsMicrosoft Excel 2016 Level 1Electrical Overview & SchematicsHigh Performing LeadershipLEAN ManufacturingPLC Overview, Troubleshooting & ProgrammingProject ManagementRobotics Theory, Operations & ProgrammingSafety- Confined Space EntrySafety- HAZWOPERSafety- HAZWOPER RefresherOther
Total Training Hours (regardless of successful completion)
As of March 24, 2023 we are only accepting applicants of individuals living in Clare, Gladwin, Arenac, Isabella, Bay, Gratiot and Saginaw counties with an annual income of $36,150. Those in Midland County must be at $42,850 or lower. If your income exceeds this amount, we can no longer accept your application and you will not be able to submit your application.
Should be Empty:

RTIG Training Application

UPDATED REQUIREMENTS

Before You Begin!!!

Applicant Information

Affidavit with Respect to Taxable Income

Review your application for completeness.

Administrative Use

College Use