Form Wrc - Virginia Worker Retraining Tax Credit Application
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5Form WRC
Virginia Department of Taxation
Tax Year Ending
________, ______
Worker Retraining Tax Credit Application
File by April 1. This credit must be approved before being claimed on your return.
See the separate instructions before completing this form.
Business Type:
Name
Federal Employer Identification Number or Social
Security Number
Corporation
Trading As
S Corporation
Street Address
Sole Proprietor
NAICS Code
Partnership
Limited Liability
City, State, ZIP Code
Company (LLC)
Approval of courses and apprenticeship programs is required. See instructions for details, including when and
where to file.
•
If application is based on noncredit courses and apprenticeship program: Complete Parts I, II and III below. File Form
WRC with the Virginia Department of Business Assistance.
•
If application is based only on noncredit courses: Complete Parts I and II below. File with Department of Business
Assistance.
•
If application is based only on apprenticeship program: Complete Parts I and III below. File with Department of
Taxation.
Part I - Description of Business Activities - Describe the principal activity of your business:
Part II - Tax Credit Based on Noncredit Courses From a Community College or Private School
Complete Schedule 1 (Form WRC), then enter the total number of courses for which this credit will be claimed and the total
credit requested. Complete a separate Schedule 1 for each noncredit course. See instructions for more information.
Total Tax Credit Requested
Total Number of Courses
(From WRC, Sch. 1, Col. E)
Total Tax Credit Requested for Noncredit
Courses From Schedule 1 (Form WRC)
Part III - Tax Credit Based on Apprenticeship Program
Complete Schedule 2 (Form WRC), then enter the name of each apprenticeship program approved by the Virginia
Apprenticeship Council for which this credit will be claimed, the total cost and credit requested.
Total Credit Requested
Program Name
Total Number of Programs
(From WRC, Sch. 2, Col. E)
Declaration - I, the undersigned officer or other person authorized to act on behalf of the business entity, have read and
understand the limitations and restrictions set forth for this credit application.
Taxpayer Signature:
Title:
Printed Name:
Date:
Phone:
Tax Preparer Signature:
Title:
Printed Name:
Date:
Phone:
Preparer Address:
Page 1
Va. Dept. of Taxation
WRC W
Rev 12/11
1901042
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