Get Lic 9140 (304) Request For Course Approval - Administrator Certification Program - Dss Cahwnet

The LIC 9140 (304) form is essential for requesting approval for courses within the Administrator Certification Program. This guide provides clear, step-by-step instructions to help users complete the form accurately and effectively through an online process.

Follow the steps to complete the form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by reviewing the instructions section of the form to ensure understanding of the requirements, including submitting the form 60 days before the course starts.
3. In the first section, select the type of program for which approval is being requested by checking the appropriate box (e.g., RCFE 40-Hour, ARF 35-Hour).
4. Indicate whether the course is co-located with other programs by selecting 'Yes' or 'No' and providing course numbers if applicable.
5. Fill in the vendor's name and approval number, followed by the vendor's mailing address, including street address, city, state, and zip code.
6. Enter the course title, dates offered (if known), business phone number, business email address, total classroom hours, and fee.
7. Provide detailed information about the instructor(s), including qualifications, and attach current resumes for each educator.
8. Describe how the course relates to business operations or resident care, the expected objectives, teaching methods, and course content in an hour-by-hour outline.
9. Explain course evaluation methods for participants and how participants will be evaluated.
10. List the types of records to be maintained and where they will be kept, along with the address or geographic area where the course will be presented.
11. Ensure to include the makeup policy for 40-hour/35-hour initial certification courses.
12. Finally, declare under penalty of perjury that the information provided is true by having the vendor or authorized representative sign and date the form.
13. After completing both sides of the application, save your changes, download it for your records, and submit it as instructed.

Complete your documents online to ensure a smooth application process.