AK Nutrition Services ServSafe Class Funding Request 01.24.25

AK Nutrition Services ServSafe Class Funding Request

Class Date: January 24, 2025
PLEASE READ

Filling out this application does NOT guarantee you will be granted funding for class. If you do not qualify for funding you can still be registered for the class and sent an invoice to pay via our online payment options or at the door.

This information will be used to register your certification on the Alaska Jobs Website, if you're not already registered. Registration through this process will in no way impact any benefits you receive from the state or county.

The Alaska CHARR Educational Fund receives STEP (State Training and Employment Program) grant funding, which funds approximately 70% ($300,000) of the program. Thank you to the State of Alaska, Workforce Investment Board, for supporting the Alaska hospitality industry.

Your application will be reviewed once you have met all the STEP Grant program requirements. Please watch your email for further direction or communication from our office.
If you do not qualify for funding of this STEP Grant, would you like to be registered for the class and have an invoice sent to you via email?*

Yes, register and invoice me for this training.No, I do not want to be registered if I do not qualify for funding.
Cancellation Policy:

A rescheduling/Administrative fee for the cost of the class will be required before rescheduling classes for any no-show.

Please contact Kat Duren if you need to reschedule your class BEFORE the class date.

STEP@alaskacharr.com

907-217-8138
By selecting "I understand", you understand and agree to the cancellation policy terms & conditions*

I understand
Participant Information

Please complete this application to apply for the Alaska STEP Grant funding and register for the ServSafe class scheduled at the Dena'ina Center on January 24, 2025.
Name*

First NameMiddle NameLast Name
Address*

Street Address

Mailing Address (PO Box, HC, etc)

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Phone Type:*

VoiceTTYVoice/TTYVideophoneAmplified Phone
Are you an Alaska Resident that has resided in the state for the past 30 days and intend to make Alaska your home?*

YesNo
Have you worked in a position that contributed to Unemployment Insurance (U.I.) in Alaska or another state with similar provisions sometime in the last five years? (Have you had a job within the last 5 years?)*

YesNo
Which classes are you interested in taking? *

ServSafe Food Protection Manager
Do you have a MyAlaska Account? (AlaskaJobs website username)*

YesNo
MyAlaska Username (To Access AlaskaJobs only):
Social Security Number:*
Date of Birth:*

MonthDayYear
Date
Gender Identity:*

FemaleMaleNon-BinaryI do not wish to answer
Which of the following best describes your US Citizenship:*

U.S CitizenU.S Permanent Resident AlienRefugee / ParoleeTemporary Work PermitNone of TheseOther
Are you currently employed?*

YesNo
Who is your current employer?*
What is your current job title?
Which of the following best describes why you are seeking training?*

In need of training to improve the prospect of obtaining or retaining employment (Keep your current job OR because you've been hired for a new job)Unemployed and receiving Unemployment Insurance (UI) benefitsUnemployed but not receiving Unemployment Insurance (UI) benefitsEmployed but likely to be displaced because of the reduction in overall employment within the business (Employees are being laid off)Employed but likely to be displaced because of the elimination of your current job (Your job position is no longer needed)Employed but likely to be displaced because of a change requiring that to remain employed, they must learn substantially different skills (Your job requires more advanced skills that you must to training for)
Do you need this training to remain a self-sufficient wage earner?*

YesNo
Do you prefer to receive your notifications from the State of Alaska via Text or Email?*

TextEmail
Please provide your race / ethnicity (check all that apply):*

White / CaucasianBlack / African AmericanAmerican Indian / Alaska NativeAsianHawaiian / Pacific IslanderI do not wish to answerOther
Are you of Hispanic or Latino heritage?

YesNoDo not wish to answer
Are you currently homeless?*

YesNo
If you experience a disability, are you able to perform the essential functions of this job or training program with or without reasonable accommodation?*

I dont have a disabilityYes, I can perform the essential functionsNo, I cannot perform the essential functions
Are you currently in the U.S Military or a Veteran?*

YesNo
Please provide the last active duty date:*

MonthDayYear
Date
Are you the spouse of a member in the armed forces who is on active duty?*

YesNo
Are you the spouse of a veteran who has a permanent, total service-connected disability or had the disability at the time of death, or died while the disability was in existence? -OR- A spouse of a service member on active duty who died or has been Missing In Action (MIA), captured in the line of duty or forcibly detained for a total of more than 90 days?*

YesNo
What is the highest level of education you have received?*

No school grades completedSome High School completedHigh School Equivalency DiplomaHigh School DiplomaSome CollegeCollege Graduate
Are you attending school?*

Yes, Middle SchoolYes, High SchoolYes, College or Technical / Vocational SchoolNo
Applicant Certification & Release of Information
My signature below affirms the certifications, media release, and release of information listed below:

✓ I certify to the best of my knowledge that the information in this application is accurate, true, verifiable, and subject to verification.
✓ I understand that the answers I have provided in this application are considered self-attestation, and I may be asked to provide proof to support my answers.
✓ I understand that falsification of information to receive grant benefits may be grounds for removal from the program, and/or I may have to repay benefits received.
✓ I certify that I am an Alaska resident, and I intend to stay in Alaska and make it my home.
✓ I certify that I have reviewed a copy of the Program Complaints and Appeals Policy, which describes the complaint and appeals process with regard to program complaints and discrimination complaints. (attached below)
✓ I certify that I have reviewed a copy of the Program and Equal Opportunity Discrimination Complaint Information document and have read and understand the contents of this document. (attached below)
✓ I agree to the use of the personally identifiable data collected on this form, including my Social Security number, for use by the Alaska Department of Labor to measure the performance and outcomes of the activities conducted under the AWIB.
✓ I understand that the funds I am applying to receive are for training or support services from the STEP program, which is funded from a percentage of employee payroll tax contributions to Unemployment Insurance. I agree to complete a survey or other inquiry regarding the training or services received from the STEP program and my employment outcome after receiving the services or training.
Program Complaints and Appeals Policy:
Program and Equal Opportunity Discrimination Complaint Information:
I grant the State of Alaska and all its administrative subdivisions the irrevocable right to use my likeness, comments, or personal story or all in media presentations, any of which may be reproduced and publicly distributed in media such as in photographs, videos, advertisements, and newspaper and magazine articles for public information, marketing, or policy discussions. This release is unconditional. I waive any right that I may have to inspect and approve the image or commentary that may be used. I release the State of Alaska and its administrative subdivisions from any claim(s) for compensation associated with the use of these images and/or commentaries.*

I DOI DO NOT
Please upload a copy of your Alaska state ID: *

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Applicant Signature:*

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Parent or Guardian Signature (If the applicant is under the age of 18)

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AK Nutrition Services ServSafe Class Funding Request

Cancellation Policy:

Participant Information

Applicant Certification & Release of Information