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Care Extender Program Forms

Forms for UCLA Care Extender ProgramAll forms are available online only now.  To open these files, you will need a PDF reader, such as Adobe Reader (click here to download).  You MUST use Adobe Reader to submit these documents electronically; any other software may not be able to digitally submit the forms.   For a guide on how to download and/or submit forms electronically, please click here: Care Extender Program Electronic Submission Guide (PDF). Note: for Mac users, you may not use the Preview application to submit the forms; you must use Adobe Reader.

If you have any questions or concerns regarding downloading, completing, or submitting the forms, please email the Website Coordinator (ce.webcoordinator@gmail.com) after you have reviewed the Care Extender Program Electronic Form Submission Guide. For questions regarding the nature of Leave of Absences, Completions, or Inactivations, please check the corresponding question on the Frequently Asked Questions (FAQ) page.

Download, fill out, and submit these forms electronically to the indicated addresses on the form:

Download, print out a hard copy, fill out with black or blue ink pen, and submit these forms to the indicated addresses on the form (send TB Questionnaire to the Data Manager):

For new Care Extenders, please read the forms below.  Do not print them: there will be copies for you to sign on Training Day.

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