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Exhibit C <br />Workforce Development Board <br />Data Intake Form <br />INSTRUCTIONS: <br />✓ Complete ALL information requested on the Intake Form <br />✓ Select FOUR of the 18 factors from the attached Early Warning Signs Checklist <br />✓ Secure client sign off on the Intake Form <br />✓ Secure the Target Employee List (TEL) from the employer <br />✓ Forward both documents to wib@cmtc.com <br />✓ Questions: call Roclo at 310-984-9892 <br />Next Steps: <br />✓ Assuming there are no questions or missing information, Rocio will forward funding request to <br />appropriate WDB representative for review <br />WDBs have committed to a reply within 5 business days of Intake Form submission <br />25D-20 <br />