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Get State Of California - Health And Human Services Agency California Department Of Social Services

TION PROGRAM 1. This form must be submitted with the LIC 9141, as all approved courses will expire on the expiration date of your vendorship. 2. In box (1) select course program type you are submitting. If more than one program, submit separate forms for each. 3. In box (2) print or type your vendor name exactly as approved. 4. In box (3) enter the vendor number exactly as approved. 5. In box (4) and (5) enter the course name and course number(s) exactly as previously approved. 6. Boxes 1-10 mus.

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