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Fill and Sign the Youth Scholarship Application West Virginia Grand Chapter Order Form

Fill and Sign the Youth Scholarship Application West Virginia Grand Chapter Order Form

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ANNEXURE C APPLICATION FOR LEARNERSHIP GRANTS: APRIL 2011 TO JUNE 2012 COMPANY DETAILS Company name Skills Development Levy Number Copy of latest EMP 201 attached SDF Name Address: Physical: Yes No Postal: Total permanent employment Telephone numbers: o Landline o o Cell o Fax number e-mail address LEARNERSHIP DETAIL: Learnership Title and Registration Number Training Provider No of 18 (1) Learners Rvalue No of 18 (2) Learners Rvalue 1 2 3 Proposed start and end date of the learnership contract Accreditation Status (please attach proof of accreditation) Physical location of site for practical workplace exposure Name and contact detail of workplace mentor/s Time to be spent on theory training (number of days) Time to be spent on structured practical workplace exposure (number of days) Equity Breakdown 18(2) learners Numbers Learnership Title 1 2 3 Provider Name African M F Start Date Accreditation Body Coloured D M End Date F Qualification for which provider is accredited Indian D M F White D M F Total D M F D Percentage DETAILED IMPLEMENTATION PLAN (to accompany application). FOODBEV SETA LEARNERSHIP GRANT APPLICATION FORM APRIL 2011 – JUNE 2012 2

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