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  • Ca Lic 9140 2023

Get Ca Lic 9140 2023-2026

California Health & Human Services AgencyCalifornia Department of Social ServicesREQUEST FOR COURSE APPROVAL ADMINISTRATOR CERTIFICATION PROGRAM Instructions: At least 60 days before the planned offering.

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How to fill out the CA LIC 9140 online

Filling out the CA LIC 9140 form is an essential step for vendors seeking approval to offer training courses for facility administrators in California. This guide provides detailed, step-by-step instructions to assist you in completing the form online efficiently and accurately.

Follow the steps to fill out the CA LIC 9140 form online

  1. Click the ‘Get Form’ button to obtain the CA LIC 9140 form and open it in your preferred editor.
  2. Select the type of program course from the provided options by marking the appropriate box, such as Adult Residential Facility (ARF) ICTP or Residential Care Facility for the Elderly (RCFE) CETP.
  3. Fill in the vendor information section, including your organization/vendor business name, address, authorized representative's name, business phone, fax, and email.
  4. Provide course information by entering the course number if it is an update, proposed course title, total hours, dates offered, and fee for the course.
  5. Indicate the format of the course by checking the appropriate box for either In-Person, Live-Stream, Self-Paced, or any other applicable formats.
  6. Complete the proposed course outline including instructor qualifications, course description, objectives, teaching methods, course content, and evaluation methods.
  7. In the vendor certification section, ensure to sign and date the form, confirming that all information is accurate.
  8. If applicable, fill out the instructor information, including any required licenses or certifications, and affirm their qualifications.
  9. Once all sections are completed, review the form for accuracy, then save changes, download it for your records, and print or share as needed.

Complete your document online today and ensure your training programs are approved!

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