Education Forms The following Pre-Licensing/Continuing Education Forms are now available in Adobe's Portable Document Format (PDF). Some documents are available in Word 97 format for your convenience.  To view and complete these pdf forms on your browser you must have Adobe Acrobat Reader 3.0 or higher on your computer. A free copy of the Adobe Acrobat Reader can be downloaded from the Adobe Web site. Additional forms will be added or revised periodically, so keep checking back.  Pre-Licensing/Continuing Education Forms Producer Licensing Bureau Education Forms Alphabetical Listing

Pre-Licensing/Continuing Education Forms in pdf format [The forms with an * following the number are now Interactive] 

Form Number PDF Format	Form Name
446-2*	Provider Certification/Renewal Application
446-3*	Course Approval Application
446-4 *	Instructor Qualification Form
446-5*	Course Attendance Record and Verification Form
446-8	Prelicense Education Requirements
446-9	California Long-Term Care, California Partnership, Annuities, and Workers' Compensation Continuing Education Requirements
446-12*	Class Presentation Schedule
446-13*	Provider Roster
446-32	Stipulation to Maintain Records Outside of California
446-40	Out-of-State Provider Jurisdiction Agreement
446-42*	Education Provider - Change of Address
Information & Filing Form	NAIC Uniform Continuing Education Reciprocity (CER) Course Filing Form
Provider Summary	Parties Interested in the Pre-licensing & Continuing Education Program Provider Summary Notice

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Pre-Licensing/Continuing Education Forms in Word format

Form Number Word 97 Format	Form Name
Not Available	Provider Certification/Renewal Application
Not Available	Course Approval Application
446-4	Instructor Qualification Form
446-5	Course Attendance Record and Verification Form
446-8	Prelicense Education Requirements
446-9	California Long-Term Care, California Partnership, Annuities, and Workers' Compensation Continuing Education Requirements
446-12	Class Presentation Schedule
446-13	Provider Roster
Not Available	Stipulation to Maintain Records Outside of California
Not Available	Out-of-State Provider Jurisdiction Agreement
446-42	Education Provider - Change of Address
Filing Form	NAIC Uniform Continuing Education Reciprocity (CER) Course Filing Form
Provider Summary	Parties Interested in the Pre-licensing & Continuing Education Program Provider Summary Notice

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Producer Licensing Bureau Education Forms-Alphabetical Listing in pdf format[The forms with an * following the number are now Interactive]

Form Name	Form Number PDF Format
California Tax Qualified Long Term Care, California Partnership, Workers Compensation  Continuing Education Requirements	446-9
Class Presentation Schedule	446-12*
Course Approval Application	446-3*
Course Attendance Record and Verification Form	446-5 *
Education Provider - Change of Address	446-42*
Instructor Qualification Form	446-4
Midwest Zone Continuing Education Reciprocity Project	Information Filing Form
Out-of-State Provider Jurisdiction Agreement	446-40
Parties Interested in the pre-licensing & Continuing Education Program Provider Summary Notice	Provider Summary
Prelicense Education Requirements	446-8
Provider Certification/Renewal Application	446-2*
Provider Roster	446-13 *
Stipulation to Maintain Records Outside of California	446-32*

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Producer Licensing Bureau Education Forms-Alphabetical Listing in Word format

Form Name	Form Number Word 97 Format
California Tax Qualified Long Term Care, California Partnership, Workers Compensation  Continuing Education Requirements	446-9
Class Presentation Schedule	446-12
Course Approval Application	Not Available
Course Attendance Record and Verification Form	446-5
Education Provider - Change of Address	446-42
Instructor Qualification Form	446-4
Midwest Zone Continuing Education Reciprocity Project	Not Available
Out-of-State Provider Jurisdiction Agreement	Not Available
Parties Interested in the pre-licensing & Continuing Education Program Provider Summary Notice	Provider Summary
Prelicense Education Requirements	446-8
Provider Certification/Renewal Application	Not Available
Provider Roster	446-13
Stipulation to Maintain Records Outside of California	Not Available

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Frequently Asked Questions  If you need further assistance, please call CDI's Producer Licensing Bureau's Education Unit at (916) 492-3064. Please be sure to include your name, telephone number, license number and e-mail address in all correspondence with the California Department of Insurance.