FAD Online Agreement Funds for Alliance Distribution (FAD) Agreement Form AT&T/IBEW, ALCATEL-LUCENT and AVAYA AGREEMENT FORM For questions about this agreement call (800) 323-3436 Participant Information First Name (required) Last Name (required) ATTUID/HRID (required) Home Street (required) Home City (required) Home State (required) ---AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Home ZIP (required) Day Time Tel (required), please use this format: 000-000-0000 Email (required) Employment Information Seniority Date (required), please use this format: YYYY-MM-DD Lay Off Date, please use this format: YYYY-MM-DD Conditions By this agreement The Alliance for Employee Growth and Development, Inc. (The Alliance) and I (the named applicant) agree to the following: 1.) I am a member of an Alliance-eligible bargaining unit of either the Communications Workers of America (CWA) or the International Brotherhood of Electrical Workers (IBEW) and I intend to use my benefits under the Agreement between AT&T/IBEW, Alcatel-Lucent or Avaya Inc., known as Funds for Alliance Distribution (FAD). If an employee elects to participate in one of the following programs; he or she will not be eligible for FAD: a) ECO/Extended Compensation Offer (Skills Match Center), b) OTP/Optional termination Pay, c) Voluntary Termination Offer (i.e. VTP, VSO, etc.) If an employee elects to participate in one of the following programs: a) SLP/Special Leave Program or b) TLA/Transition Leave of Absence; he or she will be eligible if LAID-OFF at the expiration of the leave. 2.) I authorize The Alliance to serve as my agent in providing educational, outplacement, or relocation services covered under the FAD Agreement. 3.) I understand I will continue to be eligible for services covered by the FAD Agreement until either the expenditure of $2,500 ($5,000 if covered under the Installation MOA) allocated to my individual account, or until my eligibility expires two (2) years from date of my termination due to a force adjustment program. I further understand that all reimbursement requests must be submitted to The Alliance FAD program within sixty (60) days of the expiration of my eligibility. 4.) For expenses incurred by myself chargeable to my FAD account, I understand that I will be required to submit acceptable receipts for such expenses prior to reimbursement. I also understand I must meet eligibility requirements and that once I exhaust the $2,500 ($5,000 if covered under the Installation MOA) in my individual account I am responsible for any additional charges that I may incur. Failure to meet eligibility requirements will result in a repayment liability.