Form LIC 9142A. Roster of Participants - California

Form LIC 9142A is used to create a roster of participants for courses approved under the Administrator Certification Program in California. This form is completed by course providers to document the attendance and completion of approved courses by participants.

The form consists of sections that require information about the course provider, course details, participant information, and signatures to verify attendance and completion. Important fields include the course provider's contact information, course identification, participant names, dates of participation, and appropriate signatures. It is crucial to accurately document participants' attendance and completion, ensuring that the roster is kept up-to-date and compliant with the California Department of Social Services' requirements.

An application example of this form would involve a course provider using Form LIC 9142A to create a roster of participants for their approved course. The provider would enter their contact information, specify the course details, and document participant information, including names and dates of participation. Participants would then sign the form to confirm their attendance and completion. By maintaining an accurate roster of participants through this form, the course provider can demonstrate compliance with program requirements and track the completion of approved courses in accordance with state regulations.