LIC 9142A (3/06) - Roster Of Participants - California Department of ... - dss cahwnet 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by selecting the Course Program Type. Check the appropriate box for RCFE, ARF, or GH courses.
3. Enter the Vendor Name and Instructor(s) Name in the designated fields.
4. Fill in the Course Name, Location of Course, and Course Date accurately.
5. For each participant, print their Last Name, First Name, Address, City, and Phone Number in the provided fields.
6. Complete sections for Time In and Time Out for each participant to track attendance.
7. Finally, have the Authorized Representative sign and date the form at the bottom before submission.

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