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I . <br /> 170 <br /> Formal Petition <br /> Page 3 <br /> This petition must be signed, dated and returned by the close of <br /> business November 24, 1987 to the following address: <br /> Mr. Joel C. New, Director <br /> Division of Employment and Training <br /> P. 0. Box 27687 <br /> Raleigh, North Carolina 27611 <br /> In accordance with Section 628.1(b) of the U. S. Department of Labor <br /> regulations for programs under the Job Training Partnership Act, this <br /> Formal Petition form must be used for requests for service delivery area <br /> designation. <br /> To assist in the timely completion of tasks associated with the <br /> implementation of the local JTPA program, we request that you provide the <br /> following information. The implementing agency(ies) indicated below may <br /> or may not be the same agency(ies) selected by the PIC and CEO to <br /> administer the JTPA program once the SDA is established. The use of an <br /> implementing agency allows DET to address information to a single point. <br /> 1. Administrative Entity: Agency Name <br /> Address <br /> Contact Person <br /> (Typed Name) (Title) <br /> Telephone Number ( ) <br /> 2. Grant Recipient: Agency Name <br /> Address <br /> Contact Person <br /> (Typed Name) (Title) <br /> Telephone Number ( ) <br /> 3. Agency Responsible for Private Industry Council development and <br /> appointments: <br /> Agency Name <br /> Address <br /> Contact Person <br /> (Typed Name) (Title) <br /> Telephone Number ( ) <br />