NCDOT OJT Supportive Services Form Supportive Services (SS) are a major component of the OJT Experience. The purpose of Supportive Services is to help A-OJT Trainees and OJT Highway Construction Trade Academy (HCTA) participants/completers overcome barriers that impede the application of life and social skills required for training and employment success. The definition of training and employment success for this project is the completion of all aspects of the training program and becoming/remaining gainfully employed in the Highway Construction Industry. For more details related to SS, please reference the OJT Contractor Guide and/HCTA Operational Guide. This form is used to make formal supportive services request on behalf of an A-OJT Trainee or HCTA Participant. This form can be initiated by an Employer/Prime Contractor, Consultant, HCTA Site Coordinator or NCDOT OJT Staff Member.
Name
Date:	Click or tap to enter a date.
Name:	Click or tap here to enter text.
Address:	Click or tap here to enter text.
City, State, Zip:	Click or tap here to enter text.
County:	Click or tap here to enter text.
OJT Trainee
Classification:	Click or tap here to enter text.
Hours:	Click or tap here to enter text.
Company:	Click or tap here to enter text.
HCTA Participant
Academy:	Click or tap here to enter text.
Cohort:	Click or tap here to enter text.
Supportive Service requested?
☐Advance Training	Choose an item.
☐Transportation	Choose an item.
☐Childcare services	Click or tap here to enter text.
☐Housing	Click or tap here to enter text.
☐Other	Click or tap here to enter text.
Reimbursement Activity
☐Contractor	Click or tap here to enter text.
☐Academy	Click or tap here to enter text.
☐Direct payment from OJT	Click or tap here to enter text.
Supportive Services Documentation
☐Provider Identified	Click or tap here to enter text.
☐Quote Attached	Click or tap here to enter text.
☐Approved NCDOT Vendor	Click or tap here to enter text.
Requester: Complete form, sign, save as PDF and return to ojt@ncdot.gov
Name
Email Address	Contact Information
Internal Use ONLY:
OJT Approval Status
Other Needed documents
WBS to be paid from
Other comments: