Attachment A: Notice of Intent to Apply

Notice of Intent to Apply(pdf)

Attachment A: Notice of Intent to Apply

Eligible applicants wishing to apply must submit a non-binding notification of intent to apply by October 1, 2015 to: JTED-SNAP@illinoisworknet.com.

  1. Legal Name of Applicant/Organization
  2. Mailing Address of Applicant
    (Street Address)
    (City, State Zip)
    (Please include 9 digit zip code)
  3. Organization Contact Information:
    Phone:
    Fax:
    Email:
  4. Chief Contact:
    Name:
    Phone:
    Title:
    Address:
    City, State Zip:
    Fax:
    Email:
  5. Phone Number:
    (Please include ext. # if applicable)
  6. Fax Number:
  7. FEIN Number:
  8. Geographic Region Served:
  9. Estimated Funding Request
  10. Estimated Number of Recipients to Receive JTED-SNAP Services:
  11. Estimated Expenditures Per-Participant on Work-Experience:
  12. Estimated Expenditures Per-Participant on Training Services:
  13. Targeted Sector(s):
    (Select all that apply)
  • Agriculture
  • Architecture/Construction
  • Energy
  • Finance
  • Health Care
  • Information Technology
  • Manufacturing
  • Transportation & Logistics
  • Research & Development
  • Other:


14. Targeted Participants:
(Select all that apply)

  • Category 1A
  • Category 1B
  • Category 2

Please submit any questions about this form to the JTED-SNAP FAQ section on Illinois workNetTM.