You are 60 years or older. You do NOT have to return this form for these exemptions.1. Enter your address in the search field found in the upper left corner of the map. Medi-Cal Letter Templates. A complete template includes all documents listed under each template in the order specified listed. To submit a request to CISP's office please select the document you need, download and fill out the PDF. The student is eligible for this exception until the student has resided in the state the minimum time necessary to become a California resident. Self-Support. The form is used to obtain information about you so that we can objectively determine whether you are qualified to serve as a juror in the court. Be sure to complete a new FPCA each year and every time your address changes. You have not been a member of a MediCal managed care plan for more than 90 days. 5.