Official Seal of the California Department of Education

Contact Form

Foster Youth Services Liaison - School Districts

Student Achievement and Support Division

Local Education Agency Contact Information

This contact form is for use by administrators to submit AB 490 Educational Liaison contact information for your school district (LEA). View the current listing for your county and information for other counties at the AB 490 Educational Liaison web page. All questions are required unless noted as optional. Send questions or comments to FosterYouth@cde.ca.gov.

	County Name:

	County Office of Education or School District Name:

	Foster Youth Educational Liaison Contact Information
	Foster Youth Educational Liaison First Name:
	Foster Youth Educational Liaison Last Name:
	Foster Youth Educational Liaison Email Address:
	Foster Youth Educational Liaison Phone Number: (999-999-9999)
	Foster Youth Educational Liaison 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 Email 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.