Part 1: Eligibility Information

*The Applicant is a Canadian Employer in Manufacturing
* The Applicant is an NGen Member

Part 2: Employer Information

Employer Information
*Legal Name Enter Here
*Is the legal name the same as the operating name?
*Mailing Address Enter Address Here.	*City Enter City Here	*Postal Code Enter Postal
*Is the physical address different from Mailing Address? Employer Contact
*First Name Enter Here	*Last Name Enter Here	*Position Title Enter Here
*Phone (999-999-9999) Enter Here.	Extension Enter Here	*Email Enter Here
*Company Legal Structure Make Selection.	*Business Registration Number Enter Here.	*Year Established Enter Here.
*Number of Employees in Canada Enter Here	*Number of Employees Worldwide Enter Here
* Industry Sector(s)
*Primary Industry Sector Enter Here
Secondary Industry Sector Enter Here
Tertiary Industry Sector Enter Here

Part 3: Course Program Information

Employee 1
Employee Last Name Enter Here.	Employee First Name Enter Here.	Citizenship Status Select One.	Employment Status Select One.
Course Choose a course from the list.	Start Date Enter Here	End Date Enter Here.
Employee 2
Employee Last Name Enter Here.	Employee First Name Enter Here.	Citizenship Status Select One.	Employment Status Select One.
Course Choose a course from the list.	Start Date Enter Here	End Date Enter Here.
Employee 3
Employee Last Name Enter Here.	Employee First Name Enter Here.	Citizenship Status Select One.	Employment Status Select One.
Course Choose a course from the list.	Start Date Enter Here	End Date Enter Here.
Employee 4
Employee Last Name Enter Here.	Employee First Name Enter Here.	Citizenship Status Select One.	Employment Status Select One.
Course Choose a course from the list.	Start Date Enter Here	End Date Enter Here.
Employee 5
Employee Last Name Enter Here.	Employee First Name Enter Here.	Citizenship Status Select One.	Employment Status Select One.
Course Choose a course from the list.	Start Date Enter Here	End Date Enter Here.

Employee 6
Employee Last Name Enter Here.	Employee First Name Enter Here.	Citizenship Status Select One.	Employment Status Select One.
Course Choose a course from the list.	Start Date Enter Here	End Date Enter Here.
Employee 7
Employee Last Name Enter Here.	Employee First Name Enter Here.	Citizenship Status Select One.	Employment Status Select One.
Course Choose a course from the list.	Start Date Enter Here	End Date Enter Here.
Employee 8
Employee Last Name Enter Here.	Employee First Name Enter Here.	Citizenship Status Select One.	Employment Status Select One.
Course Choose a course from the list	Start Date Enter Here	End Date Enter Here.
Employee 9
Employee Last Name Enter Here.	Employee First Name Enter Here.	Citizenship Status Select One.	Employment Status Select One.
Course Choose a course from the list.	Start Date Enter Here	End Date Enter Here.
Employee 10
Employee Last Name Enter Here.	Employee First Name Enter Here.	Citizenship Status Select One.	Employment Status Select One.
Course Choose a course from the list.	Start Date Enter Here	End Date Enter Here.

The information provided on this Form (“Application”) for NGen Accelerating Manufacturing Performance Upskilling Project (AMP-UP) co-investment is business information that will be used by the NGen team in its review of the attached application.

Part 6: Employer Declaration

For your application to be eligible for funding, all of the following mandatory eligibility criteria must be met. You must agree with and select ALL of the declaration check boxes below before submitting your completed application. Please ensure that this declaration is true and correct to the best of your knowledge and belief. If at any time in the future, NGen Canada finds any item attested to in the declaration to be untrue, the Employer may be deemed ineligible for future NGen Canada funding and liable for any costs incurred.

☐	I represent the employer named above (“Employer”) and have authority to submit this Application on the Employer's behalf
☐	The Employer has a job available for each Participant upon completion of training and the job(s) is/are located in Canada.
☐	The Employer is not in receipt of any other government training funds that duplicate this request.
☐	Training is directly related to the current needs of the business and the available job.
☐	To maximize the number of companies impacted, the maximum AMPUP training allowance per company is limited to $10,000 ($5,000 of NGen matching funds).
☐	The Employer agrees that NGen Canada reserves the right to contact participants, trainers or any other person in order to substantiate training activities, records or other related matters.
☐	The Employer is aware that NGen Canada will ask the Employer and Participant employees to participate in follow-up surveys about the program to support continuous improvement and accountability, and, if approved, will commit to participating in these surveys and ensuring its employees do the same to the best of its ability.
☐	All determinations regarding eligibility are, and shall remain, at the sole discretion of NGen Canada.
☐	Submission of this form does not guarantee the awarding of a grant or any reimbursement under a grant.

Applicant Information
Signature	Name (Typed) Typed Name.	Date Date
NGen Approval
Signature	Name (Typed) Typed Name.	Date Date