ࡱ> []Zc /bjbjZZ 8V8b\8b\ettttt8<l$d"0ttt&sssXttssss,s<0lsJ$ J$sJ$tsd"s lJ$> :: STATE OF CALIFORNIA DEPARTMENT OF EDUCATION REQUEST FOR VOLUNTEER/UNPAID TRAINEE AUTHORIZATION FOR MINOR CDE Form B1-6 (Rev. 04-12) (Print Information) Minors InformationMinors Name (First and Last)Home PhoneBirth DateHome AddressCityZip Code Local Education Agency InformationLEA NameLEA PhoneLEA AddressCityZip CodeList educational program for this placement: To be filled in by employer or agency of placement.Business or Agency of Placement NameBusiness PhoneBusiness AddressCityZip CodeMinors services during volunteer/unpaid training:Employers Name (Print First and Last)Employers SignatureDate To be signed by parent or legal guardian. As the parent or guardian, I hereby grant permission to the above minor to volunteer or be placed for unpaid training. I hereby certify that, to the best of my knowledge, the information herein is correct and true. Parent/Guardians Name (Print First and Last)Parent/Guardians SignatureDate Certification In compliance with California Education Code 51769, subject to certain exceptions, during the educational unpaid training placement, the LEA is responsible for providing workers compensation insurance covering that minor. I hereby certify that, to the best of my knowledge, the information herein is correct and true. 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Davis,Maria volunteer Normal.dotm Davis,Maria2Microsoft Office Word@G@ܑK(@,@,ocIdItemGuid_dlc_DocIdUrl %7373f6ee-0177-487b-8e62-7da6e8dd31da%7d9c3cd3-e6f3-48a7-87c5-c400500c03e8https://www.adventisthealth.org/central-valley/_layouts/DocIdRedir.aspx?ID=7373f6ee-0177-487b-8e62-7da6e8dd31da, 7373f6ee-0177-487b-8e62-7da6e8dd31da ?@ABCDEFGHIKLMNOPQSUVWXYb\_v`acdefghijklmnowxyz{|}RRoot Entry F0 L^Data ,{1Table7J$WordDocument8VSummaryInformation(JDocumentSummaryInformation8@,CompObjrMsoDataStore 0 L0 L  !"#$%&'()*+,-./0123456789:;=>?ABCDEFGHIJKLMNOPRTUV  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89qDocumentLibraryFormDocumentLibraryFormDocumentLibraryForm This value indicates the number of saves or revisions. 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Dept. of Education  KUnpaid Trainee Authorization Form - Work Experience (CA Dept of Education) Title8h _dlc_DocId_dlc_D