MILWAUKEE ELECTRICAL JATC

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Stipend Pay Application Form

SPA-v1.0

INSTRUCTIONS:

For Certified Technicians (CTECH) or Residential Wireman (RW) that would like to receive Stipend Pay for classes taken outside of the MeJATC, you must complete the application below, as well as attach/upload any of the following applicable documentation:

Completed Employer Affidavit Form, attesting that your employer is not paying you for the training time(Double Dipping)
Evidence of course attendance/completion
Course Outline/Syllabus
Documentation showing Course Date(s) & Course Length (total classroom hours, start/end times)
List of Certification(s) earned by completing the course
Copy of any Completion Certificates and/or Cards earned

Stipend Pay Information:

CTECH Stipend Pay - 20 hours, paid at $20 per hour, per calendar year (See Sound and Communication Agreement Section 12.07(a)(5) for details)
RW Stipend Pay - 20 hours, paid at $25 per hour, per calendar year (See Residential Wireman Agreement Section 10.02(a) for details)

Your completed application and supporting documents will be reviewed by the MeJATC office.

If there is additional information or documentation required, the MeJATC office will reach out via email or phone to request the needed information.

Classification *

Employer/Contractor Name *

First Name *

Middle Initial

Last Name *

Street Address *

City *

State *

Zip Code *

Email *

Phone Number *

IBEW Member Number *

Course Title *

Course Location *

(City, State, and School or Course Provider)

Course Description *

Start Date *

End Date *

Course Length(In Hours) *

Supporting Documentation

Upload Supporting Documents Here.(i.e., Course Outline, Course Syllabus, Sign-in-Sheet(s) etc...)

NOTE - Maximum of 5 Documents

Supporting Document-1

Supporting Document-2

Supporting Document-3

Supporting Document-4

Supporting Document-5

Certifications Earned

List any Certifications that were earned as a result of successfully completing this course. Please upload accompanying certificates for your TradeSchool record.

If there were no certificates earned, then this section could be skipped.

List Certifications

Certificate-1

Certificate-2

Certificate-3

Certificate-4

Certificate-5

Employer Affidavit

The Employer Affidavit Form must be completed and attached to this application for your stipend pay to be approved.

Employer Affidavit Upload *

Signature *

Use your mouse, finger, or touch device to write your signature.

* Required Fields