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JS-53-(8/05

)
Trade Adjustment Assistance (TAA)
Request for Extension of Training
Name Social Security Number Job Center
Address Phone Petition Number
Training Facility Training Program
Start Date of TAA-Approved Training Previously Approved End Date of Training
Instructions: To request an extension of TAA-approved training, complete and submit this form to the trainee’s TAA counselor at least
two weeks before the scheduled end date of training. Please attach the most recent progress report or transcript. Please note: If the
extension is requested and approved because the trainee needs to repeat a module, the TAA Program will not be responsible for
additional costs incurred. The goal of the TAA program is to assist workers return to suitable employment. The TAA counselor may
need to reassess the trainee’s job readiness and ability to complete training within TAA program parameters.

Why is a training extension necessary?

Indicate the proposed training ending date and number of additional weeks of training requested:
Would the extension involve any breaks in training? Yes No If so, provide dates of any breaks in training.

Check one: The extension is necessary to assist in the completion of the training program originally approved.
The extension request is based on a desire to add to the training program originally approved.
If seeking to add to the training program, why is the additional component necessary?

Why was the component omitted from the original training proposal?

Are there any additional costs associated with this extension? Yes No If yes, specify costs below.
Tuition Books Supplies Fees Other:
$ $ $ $ $

Signature of trainee Date

Printed name of training facility’s authorized Signature of training facility’s authorized Date
representative representative
Phone Fax Email

For use by Connecticut Department of Labor TAA Counselor
Would the proposed extension cause the training plan to exceed the maximum number of allowable
Yes No
weeks of TAA training?
Would there be any additional TAA costs associated with extending the training, not already outlined
above by the training facility? If yes, estimate additional costs: Yes No
transportation allowance: $ subsistence allowance: $
Would the proposed extension cause the training to exceed the maximum cost allowable for TAA
Yes No
training?
Recommendation for training extension: Approve Deny Reason for recommendation:

Signature of TAA counselor Date