Official Seal of the California Department of Education

Contact Form

Foster Youth Services Liaison - Charter Schools

Student Achievement and Support Division

Local Education Agency Contact Information

Use this form to submit AB 490 Educational Liaison contact information for your local educational agency (LEA). View the current listing for your county and information for other counties https://www.cde.ca.gov/ls/pf/fy/ab490contacts.asp. Send questions or comments to FosterYouth@cde.ca.gov.

	County Name:

	Charter School (LEA) Name:

	Foster Youth Educational Liason Contact Information
	Foster Youth Educational Liason First Name:
	Foster Youth Educational Liason Last Name:
	Foster Youth Educational Liason E-mail Address:
	Foster Youth Educational Liason Phone Number: (999-999-9999)
	Foster Youth Educational Liason Phone Number Extension: (if applicable)

	LEA Mailing Address for JV-535 Forms
	Street Name:
	City:
	State:
	Zip Code:

Is this contact information an addition to the current listing or a replacement?

An addition

A replacement

	Requestor's Contact Information
	Requestor's First Name:
	Requestor's Last Name:
	Requestor's E-mail Address:

	Additional Comments: (optional)

Once you select the Submit button below, your survey responses will be sent to the Student Achievement and Support Division and you will be redirected to the AB 490 Educational Liaisons Web page.