Get Lic 9142a (1203) - Roster Of Participants - For Vendor Use Only - Dss Cahwnet

This guide provides clear, step-by-step instructions for completing the LIC 9142A (1203) form online. Designed for vendor use, this document aids in the proper roster documentation of participants who have completed required training courses.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to access the form and open it in the editor.
2. In section (1), select the appropriate course program type by checking the box corresponding to either RCFE Initial 40-Hour Course, RCFE CEU, GH Initial 40-Hour, GH CEU, ARF Initial 35-Hour Course, or ARF CEU.
3. Enter the vendor name in the designated field under section (2). This should reflect the official name of the organization providing the training.
4. In section (5), fill in the course name. Be precise to ensure clarity regarding which course is being reported.
5. For each participant, complete fields for their last name, first name, and mailing address. Ensure all details are printed legibly to avoid any miscommunication.
6. Continue listing each participant's information, ensuring that the city and zip code are accurate.
7. In section (7), provide the name of the authorized representative responsible for submitting the form. Include the first name, last name, and title in section (8).
8. Input the vendor number in section (9) as required for identification.
9. Finally, the authorized representative must sign the form to validate its authenticity. Ensure the signature is included before submission.
10. Once all sections are completed, save your changes, and proceed to download, print, or share the form as needed.

Complete your forms online efficiently and accurately today.