Download Delta Workforce Investment Area

Delta Workforce Investment Area
South Delta Planning & Development District
Request for Payment of GED Incentive
The Delta WIA Youth Incentive Policy allows a $200 cash incentive payment for youth participants who
pass the GED test. These funds will be paid from SDPDD – DWIA funds. This form should be completed
by the youth subcontractor when requesting payment of the $200 cash incentive for passage of the GED
test.
AGENCY:
_______________________________________________
DATE:
_______________________________________________
Participant’s Name:
___________________________________________
Participant’s Social Security Number:
__________________________
Date Participant Passed the GED Test:
__________________________
Amount Requested:
$ 200.00
CERTIFICATION
I certify that the above named participant has passed the requirements for obtaining a GED in the
State of Mississippi. I further certify that the above named participant has not previously received
the cash incentive payment. A copy of the GED Certificate is attached to this request.
_______________________________________ ________________
Signature of Agency Representative
Date
_______________________________________ ________________
Signature of Participant
Date
APPROVAL
Approved by the Delta Workforce Investment Area.
_______________________________________ ________________
Signature of DWIA Representative
Date
Payment should be submitted to the DWIA staff for notation and will then be forwarded on to the
Agency for presentation to the participant.
Cash incentive form