(covers the period October 1, 2016 through September 30, 2017)
An asterisk (*) denotes a required field. Complete the entire form during this Internet session and select the "Submit Form" button at the end/bottom of the form to send the form electronically to the California Department of Education (CDE). If you have completed all fields, you will see a screen with a "Confirmation Number" when you "submit." An automated e-mail confirmation will be sent if an e-mail address is entered in #9.
IMPORTANT WEB BROWSER NOTE: When your Web browser displays an alert prompt, do NOT check the box next to 'Prevent this page from creating additional dialogs.' If you do, you will need to restart your Web browser and start over.
Please e-mail CDE if you have questions about this form.