Form: Application 2017-18 - CalWORKs (CA Dept of Education)

  • Doc File 76.00KByte



California Department of Education Enclosure 2

2017–18 CalWORKs County Joint Application

(Cover Page)

Funding to Provide Instructional and Job Training

Adult Schools and Regional Occupational Centers and Programs (ROCPs)

Mail application to:

Gary Page, Education Programs Consultant

Career Technical Education Leadership and Instructional Support Office

California Department of Education

1430 N Street, Suite 4202

Sacramento, CA 95814-5901

Applications must be received by Friday, December 1, 2017.

Please Print

|County Code | | | |

|County Name | | | |

| |

|CalWORKs COUNTY COORDINATOR |

|Coordinator Name | | | |

|Agency | | | |

|Mail Address | | | |

|City/Zip Code | | | |

|Telephone | | |Fax | | |

|E-mail | | | |

|COUNTY OFFICE OF EDUCATION |

|Superintendent Name | | | |

|Street Address | | | |

|City/Zip Code | | | |

|Signature of Superintendent | | | |

|COUNTY DIRECTOR OF SOCIAL SERVICES |

|County Director Name | | | |

|Street Address | | | |

|City/Zip Code | | | |

|Signature of County Director | | | |

| | |

The applicant guarantees that programs funded with CalWORKs funds will comply with Title VI and Title VII of the Civil Rights Act of 1964, the California Fair Employment Practices Act, and Chapter 4 (commencing with Section 30) of Division I of Title 5, California Administrative Code. A statement of compliance with Title VI of the Civil Rights Act of 1964 has been filed with the State Superintendent of Public Instruction. The applicant also guarantees that programs funded with CalWORKs funds will comply with the Title IX (nondiscrimination on the basis of sex) of the Education Amendments of 1972 and the Age Discrimination Act of 1975.

The applicant agrees to make programs funded with CalWORKs available to handicapped persons in compliance with the Americans with Disabilities Act of 1990, Section 3, and Section 504 of the Rehabilitation Act of 1973.

The applicant certifies to use its CalWORKs funds for educational activities designed to increase self-sufficiency, job training, and work for CalWORKs clients.

California Department of Education Enclosure 2

2017–18 CalWORKs County Joint Application

Funding to Provide Instructional and Job Training

Adult Schools and ROCPs

Applications must be received by Friday, December 1, 2017.

Please Print

|County Code | | | |

|County Name | | | |

|Total County Allocation |$ | | |

| | | |

□ County does not have an Adult Education Program □ County does not have an ROCP

| |District Name | |Adult School Name |2016–17 CalWORKs Student | |

| | |Adult School CDS Code | |Enrollment | |

|District Code | | | |(Unduplicated) |Funds Requested |

| | | | | |($) |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | |

|Total | | |

| |District Name | |ROCP Name |2016–17 | |

| | |ROCP | |CalWORKs | |

|District Code | |CDS Code | |Student Enrollment |Funds Requested |

| | | | |(Unduplicated) |($) |

| | | | |( | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | |

|Total | | |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download