ࡱ> _a^o Ebjbj 8ZzfzfpYY8LA"t%%%%%UUU+"-"-"-"-"-"-"$ $&8Q"933"99Q"YY%%f"9RY%Y8%+"9+"%wy^"|"0")))tU"wUUUQ"Q"UUU"9999)UUUUUUUUU : STATE OF CALIFORNIA DEPARTMENT OF EDUCATION REQUEST FOR UNPAID TRAINEE AUTHORIZATION FOR MINOR CDE Form B1-6 (Rev. 04-12) (Print Information) Minors InformationMinors Name (First and Last)Home PhoneBirth DateHome AddressCityZip Code Local Education Agency InformationLEA NameLEA PhoneLEA AddressCityZip CodeList educational program for this placement: To be filled in by employer or agency of placement.Business or Agency of Placement NameBusiness PhoneBusiness AddressCityZip CodeMinors services during unpaid training:Employers Name (Print First and Last)Employers SignatureDate To be signed by parent or legal guardian. As the parent or guardian, I hereby grant permission to the above minor to participate or be placed for unpaid training. I hereby certify that, to the best of my knowledge, the information herein is correct and true. Parent/Guardians Name (Print First and Last)Parent/Guardians SignatureDate Certification In compliance with California Education Code 51769, subject to certain exceptions, during the educational unpaid training placement, the LEA is responsible for providing workers compensation insurance covering that minor. I hereby certify that, to the best of my knowledge, the information herein is correct and true. 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Y ] c   \ E  !"$&')*+@ @"  (    v0>MSIPCM4eb54f4ba42df8a7793255bf{"HashCode":-1902053478,"Height":792.0,"Width":612.0,"Placement":"Footer","Index":"Primary","Section":1,"Top":0.0,"Left":0.0}C"` 0(  B S  ?r;/<k,p -p **F44F9*urn:schemas-microsoft-com:office:smarttagsState9*urn:schemas-microsoft-com:office:smarttagsplace R"&F"&'CF{|| GG^^_+MNV&F88hltuwxGG+"&'CFK{KbjB-  6 W   *0 O KIi~gyLLdLYl ,P !v$.$"$W(-j)q**]*@M.{1v2V\6v:G;jE<k<=Q=7[>?wA~CmEmkFnJZ[KuMaPQ2QScR|`Sk\U)7VW9 X@XZuZ2[??^RcMdnekg@h\h=manSpvtA#t[7tttTwsJy~bzHxzw|%rN p9sM!mWJg^(@I\WOsX%+1WJ@xM*n%Y,Uf/N;|R6=gg~{ao6Mq8u8kwa4:.H~A [U'I~C6 Dto@E(@UnknownG.[x Times New Roman5Symbol3. .[x Arial7..{$ CalibriC.,.{$ Calibri LightA$BCambria Math"1hⴧⴧNc  !842QHP ?K2!xx8 JUnpaid Trainee Authorization Form - Work Experience (CA Dept of Education)The REQUEST FOR VOLUNTEER/UNPAID TRAINEE AUTHORIZATION FOR MINOR form must be completed and submitted to the local education agency of minor's enrollment. volunteer Davis,MariaAlvarez,Valeria Oh+'0p   , 8 DPX`hLUnpaid Trainee Authorization Form - Work Experience (CA Dept of Education)The REQUEST FOR VOLUNTEER/UNPAID TRAINEE AUTHORIZATION FOR MINOR form must be completed and submitted to the local education agency of minor's enrollment. Davis,Maria volunteerNormalAlvarez,Valeria2Microsoft Office Word@F#@ܑK(@y@y ՜.+,D՜.+,L hp  +Calif. Dept. of Education  KUnpaid Trainee Authorization Form - Work Experience (CA Dept of Education) Title P,L`8MSIP_Label_f52c3125-80bb-477a-b344-92315e736908_Enabled8MSIP_Label_f52c3125-80bb-477a-b344-92315e736908_SetDate7MSIP_Label_f52c3125-80bb-477a-b344-92315e736908_Method5MSIP_Label_f52c3125-80bb-477a-b344-92315e736908_Name7MSIP_Label_f52c3125-80bb-477a-b344-92315e736908_SiteId9MSIP_Label_f52c3125-80bb-477a-b344-92315e736908_ActionId<MSIP_Label_f52c3125-80bb-477a-b344-92315e736908_ContentBitstrue2023-04-28T17:26:00Z Standard(f52c3125-80bb-477a-b344-92315e736908(d931cb4a-3984-4328-9fb6-96d7d7fd51b0(e765b08f-bc5d-4c1c-9788-c2cd8bf8188d2  !"#$%&'()*+,-/012345678:;<=>?@ABCDEFGHIJKLMOPQRSTUWXYZ[\]`Root Entry FAxybData .{1Table9)WordDocument8ZSummaryInformation(NDocumentSummaryInformation8VCompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q