cscpa template

California State Care Providers Association

Serving Children - Foster Parents - Adoptions - Guardianship - Kinship

Aubrey Manuel, President
Telephone (323) 846-0007
Email: cscpa@fosterparents.com

Name(s): _____________________________________________

______________________________________________________________________________________________________________________ Address City Zip Code

Telephone: _(_______)_____________________ County:_________________________

e-mail: ____________________________________________________

Areas Of Expertise:

___________________________________________________________

Committees you would like to serve on:

___________________________________________________________

FEE: $35 per person

Please send this form with a check to: CSCPA, P.O. Box 4776, Chatsworth, CA 91313

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