Form LIC 9140A. Request to Add or Replace Instructor - California

Form LIC 9140A is used in California to request the addition or replacement of an instructor in a course approved under the Administrator Certification Program. This form is completed by course providers who need to add a new instructor or replace an existing instructor for their approved course.

The form consists of sections that require information about the course provider, the current instructor (if applicable), and the proposed new instructor. The important fields include the course provider's contact information, details about the current instructor (if applicable), and the qualifications and experience of the proposed new instructor. It is crucial to accurately provide all necessary information concerning the new instructor's qualifications and experience to ensure compliance with the requirements set by the California Department of Social Services.

An application example of this form would involve a course provider submitting Form LIC 9140A to request the addition or replacement of an instructor in their approved course. The provider would provide their contact information and explain the reason for the request. If there is a current instructor, the provider would provide information about them as well. Finally, the provider would provide detailed information about the proposed new instructor, including their qualifications, experience, and any relevant certifications. By submitting this form, the course provider can ensure that their course continues to meet the required instructor qualifications in compliance with state regulations.