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LIC 9142A (3/06) - Roster Of Participants - California Department of ... - dss cahwnet 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by selecting the Course Program Type. Check the appropriate box for RCFE, ARF, or GH courses.
- Enter the Vendor Name and Instructor(s) Name in the designated fields.
- Fill in the Course Name, Location of Course, and Course Date accurately.
- For each participant, print their Last Name, First Name, Address, City, and Phone Number in the provided fields.
- Complete sections for Time In and Time Out for each participant to track attendance.
- Finally, have the Authorized Representative sign and date the form at the bottom before submission.
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