(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.
Please e-mail CDE if you have questions about this form.