Contractor Stipend Request

Primary Contact Information

Contractor companies may be eligible for a stipend to offset the expense for sending employees, who are working in the Weatherization Assistance Program, to attend training. Contractor Companies (not the employees) must submit the stipend request.

Only company owners or sole proprietors may submit stipend requests.

Please note that stipend requests must be submitted within 30-days of the date of training or they will be denied. The year end (September 30) deadlines may vary from one year to the next.

Question Title

* 1. Primary Company Contact

Name

Email Address

Phone Number

Question Title

* 2. Is this request for you?

Yes

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* 3. Provide the full company name and mailing address: (This is where the payment will be sent.)

Company *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

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* 4. Contractor W9

A W9 must be on file with MPHI for payment. Attach here if it has not already been submitted. Alternatively, please email to MDHHS-MiTEC@Michigan.gov with "W9 for (Company Name) - Stipend Payment' in the subject line.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 5. Retention Agreement

A retention agreement must be on file with the agency to receive stipends. Attach here if it has not already been submitted. Alternatively, please email to MDHHS-MiTEC@Michigan.gov with "Retention Agreement for (Company Name) - Stipend Payment' in the subject line. NOTE: Will be requested from the agency if not submitted.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File