ࡱ> Z\Yg /bjbjVV 8Vr<r<e\\8<>"""""OQQQQQQ$z ,uu""R""OO"@ d$3F;0"y""\"7KuuQ"\ |: 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. Authorizing Personnels Name and Title (Print)Authorizing Personnels SignatureDate     CopyLocal Education Agency; Employer or Agency of Placement; Parent or Legal Guardian +,chimrx|~ƹ֭|l\L<\h(h7[>6CJOJQJaJh(hV\66CJOJQJaJh(hYl6CJOJQJaJh(h(5CJOJQJaJh\5CJOJQJaJhwCJOJQJaJhsCJOJQJaJhaPCJOJQJaJhv2CJOJQJaJhv25CJOJQJaJh(hv25CJOJQJaJh(hv2CJOJQJaJhW CJOJQJaJh(hv2CJOJQJaJiVykd$$Ifl((  t 0(644 lalp yt $Ifgd(gd[$a$gd\gdv2  !0*gdv2  !`'gdv2 ³tdUUFU7Fh hYlCJOJQJaJh h\CJOJQJaJh h(CJOJQJaJh h'I6CJOJQJaJh hW6CJOJQJaJh h(6CJOJQJaJh h!6CJOJQJaJh h!CJOJQJaJh hTwCJOJQJaJh h!5CJOJQJaJh hq5CJOJQJaJh(h[6CJOJQJaJh\6CJOJQJaJ:kd$$IflPr !($  t(644 lalp2yt $Ifgd $Ifgd\h $Ifgd\KB $Ifgd\kd$$Iflr !($  t(644 lalp2yt $$Ifa$gd ?kdi$$Iflr !($  t(644 lalp2yt $If]gd $Ifgd\      ;kdQ$$Iflr !($  t(644 lalp2yt $$If]a$gd $$Ifa$gd    6 r ƷyiYI:+:h hA CJOJQJaJh hTwCJOJQJaJh h5CJOJQJaJh hN5CJOJQJaJh h95CJOJQJaJh hU5CJOJQJaJh h(5CJOJQJaJh(hv2CJOJQJaJh hv2CJOJQJaJh httCJOJQJaJh htt5CJOJQJaJhCJOJQJaJh h\CJOJQJaJh hiCJOJQJaJ  5 6 7 8 9 zykd/$$Ifl((  t 0(644 lalp yt $Ifgd8k9 : C D N wnw $Ifgd8k $$Ifa$gd |kd$$IflPFX \  t(6    44 lalpyt N O P Q R S T ||||| $Ifgd8kzkd$$IflFX \  t(6    44 lalpyt T U a b g h q UIIIII $$Ifa$gd kd&$$IflrX !(\ hT t(644 lalp2yt q r WQQ$Ifkd$$IflrX !(\ hT t(644 lalp2yt  $Ifgd(akd$$IflP0x(x t(644 lalpyt  |p| $$Ifa$gd $Ifgd\ykdp$$Ifl((  t 0(644 lalp yt    wkw $$Ifa$gd $$Ifa$gd |kd! $$Ifl4F $  t(6    44 lalpyt      9 A J K k n r ĵĈxiYIY9Yh hnJ5CJOJQJaJh h(5CJOJQJaJh hU5CJOJQJaJh(hA CJOJQJaJh hv26CJOJQJaJh hv2CJOJQJaJh hn%CJOJQJaJh h!CJOJQJaJh hCCJOJQJaJh hiCJOJQJaJh h(CJOJQJaJh hTwCJOJQJaJh hCJOJQJaJ       zzzzz $Ifgd\|kd $$Ifl3F $  t(6    44 lalpyt   ( ) . / 8 UIIIII $$Ifa$gd kdk $$Iflr !($  t(644 lalp2yt 8 9 l m WNN $Ifgd\kdS $$Iflr !($  t(644 lalp2yt m n o p q JIkd $$Ifl(( t(644 lalp yt $Ifgd\akd1 $$IflP0(4 t(644 lalpyt q r s t u v w $Ifgd\Ikd! $$Ifl(( t(644 lalp yt w x ."" $$Ifa$gd kd $$Iflr (  t0(644 lalp2yt  $$Ifa$gd  .,# $Ifgd(kd$$Iflr (  t0(644 lalp2yt  _ ` ²whwYI:h h=mCJOJQJaJh h=m6CJOJQJaJh hv$CJOJQJaJh hV\6CJOJQJaJh hpCJOJQJaJh h8uCJOJQJaJhi6CJOJQJaJh(hi6CJOJQJaJh(h6CJOJQJaJh;6CJOJQJaJh hA 5CJOJQJaJh hN5CJOJQJaJh h(5CJOJQJaJ ` $Ifgd??^ $Ifgd6=xxgdRcgd;Ykd$$Ifl ((  t (644 l` alp yt    UI@I7I $Ifgd??^ $Ifgd6= $$Ifa$gd kdr$$Iflr`( % t(644 lalp2yt      ' ( ) G [ Ͽ߯ueXK$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] /V dddg / !$' 9 N T q   8 m q w  ' n /  "#%&()*8@0(  B S  ?78<<0FF09*urn:schemas-microsoft-com:office:smarttagsplace9*urn:schemas-microsoft-com:office:smarttagsState :-0-0 rrs_` h-0rv~-0K{KbjB-  6 W   *0 O KIi~gyLLdLYl ,P !v$.$"$W(-j)q**@M.{1v2V\6v:G;k<=Q=7[>?wA~CmEmkFnJZ[KuMaP2QScR|`Sk\U)7VW9 X@XZuZ2[??^RcMdnekg@h\h=manSpvtA#t[7tttTwsJy~bzHxzw|%rN p9!mWJg^(@I\WOs+1WJ@xM*n%Y,Uf/N;|R6=gg~{ao6Mq8u8kwa4:.H~A [U'I~C6 Dto@/@UnknownG*Ax Times New Roman5Symbol3. *Cx ArialA$BCambria Math"hRfNc'A  !8r43QHP ?K2!xx JUnpaid Trainee Authorization Form - Work Experience (CA Dept of Education)The REQUEST FOR VOLUNTEER/UNPAID TRAINEE AUTHORIZATION FOR MINOR form must be completed and submitted to the local education agency of minor's enrollment. volunteerChristopher MattsonOh+'0p   , 8 DPX`hLUnpaid Trainee Authorization Form - Work Experience (CA Dept of Education)The REQUEST FOR VOLUNTEER/UNPAID TRAINEE AUTHORIZATION FOR MINOR form must be completed and submitted to the local education agency of minor's enrollment.  volunteer Normal.dotmChristopher Mattson39Microsoft Office Word@Ɣ @t@#@D$՜.+,0L hp  +Calif. Dept. of Education  KUnpaid Trainee Authorization Form - Work Experience (CA Dept of Education) Title  !"#$%&'()*+-./012345689:;<=>?@ABCDEFGHJKLMNOPRSTUVWX[Root Entry Fd$]Data ,{1Table7"WordDocument8VSummaryInformation(IDocumentSummaryInformation8QCompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q