Form

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Please submit the following information so we can provide access to Cell-Ed's LMS dashboard for you as a Designated Authorized Administrator.

First name*

Last name*

Job title*

Email*

CDSS Program(s)*

CalFresh - Fresh Success

CalFresh E&T

CalWORKs

CalWORKs - Indian Health Clinics

CalWORKs - Tribal TANF

CalWORKs-HVP

Community Based Organization (CBO)

General Relief / General Assistance

Refugee Support Services

Other

California County - Multi-Select

California Statewide

Tribal Partner

Alameda

Alpine

Amador

Butte

Calaveras

Colusa

Contra Costa

Del Norte

El Dorado

Fresno

Glenn

Humboldt

Imperial

Inyo

Kern

Kings

Lake

Lassen

Los Angeles

Madera

Marin

Mariposa

Mendocino

Merced

Modoc

Mono

Monterey

Napa

Nevada

Orange

Placer

Plumas

Riverside

Sacramento

San Benito

San Bernardino

San Diego

San Francisco

San Joaquin

San Luis Obispo

San Mateo

Santa Barbara

Santa Clara

Santa Cruz

Santa Monica

Shasta

Sierra

Siskiyou

Solano

Sonoma

Stanislaus

Sutter

Tehama

Trinity

Tulare

Tuolumne

Ventura

Yolo

Yuba

Name of Supervisor who authorized L4L/S4L LMS access*

Email of supervisor who authorized L4L/S4L LMS access*