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Get CA HHSA DSS LIC 9142A 2006

CATION PROGRAM • • Provide the information requested below for all participants. Mail a copy of this roster within 7 days of course completion to the Administrator Certification Section at: • • Please submit a separate roster for each course/program type. Complete a separate roster for each day of course instruction. 744 “P” Street, M.S. 19-47, Sacramento, CA 95814 (1) Course Program Type (Check one box): ■ ■ RCFE Initial 40-Hour Course RCFE CEU ■ ARF Initial 35-Hour C.

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