International Technical Cooperation

Please type in all necessary information below, print and sign this form. The form can be mailed to: Division of International Technical Cooperation, Room 2190, 2 Massachusetts Avenue, NE., Washington, DC 20212-0001 or faxed to (202) 691-7900. A PDF version of the Training Payment Agreement form is also available for download.

Training Payment Agreement

TRAINEE INFORMATION
Surname: Given Name:
Job Title: Employer:
Address: (Street or P.O. Box, City, and Country)
Telephone: Fax:
E-mail:
TRAINING AND COST INFORMATION
Training Program: Dates of Training:
Tuition: $
Total Amount Payable to the U.S. Bureau of Labor Statistics (BLS):$ Payment, in U.S. dollars, is due before the trainee’s arrival at BLS. Do not include money that should be paid directly to the trainee including allowances for housing, meals, local transportation, and medical insurance. Please contact us by email for wire transfer information. BLS will only accept payment by check from a U.S. chartered bank.
Payment Method:
Wire Transfer Check Credit Card
Credit Card Information (if paying by credit card):
VISA MasterCard AmericanExpress Discover
Card Number:
Expiration Date:
Cardholder Name:
Cardholder Signature:
Cardholder Billing Address : (Street or P.O. Box, City, and Country)
FINANCIAL SPONSOR INFORMATION
Name and Title of Official Responsible for Tuition Payment:
Organization:
Mailing Address: (Street or P.O. Box, City, and Country)
Telephone: Fax:
E-mail:

Signature of Official Responsible For Tuition Payment:

___________________________________________________________________


Date of Signature: _____________________

Last modified: November 15, 2011

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