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Form J-4A Instructions

Instructions for completing the Form J-4A for fiscal year 2013-14.

The information entered on Form J-4A must be entered in the electronic excel file which can be found on the California Department of Education’s (CDE’s) J-4 County School Service Funds Reimbursement Web page [].

The Curriculum and Instruction Steering Committee (CISC) Chair should complete the Form J-4A to report required information for each 2012–13 CISC meeting that occurred from July 1, 2012 through June 30, 2013. In addition, each CISC subcommittee lead should complete a Form J-4A to report information about 2012–13 subcommittee meetings that occurred from July 1, 2012 through June 30, 2013. A completed sample is available for your reference.

Section I.
  • Provide the name of the Committee/Subcommittee and the contact information of the meeting convener. Typically the convener is the CISC Chair for the CISC meetings, and each CISC subcommittee lead for his/her respective subcommittees. If other individuals assisted in the preparation of this report or helped convene the meetings, provide their contact information under Other Contact Name.
Section II.
  • In the first column, identify each meeting by date (e.g., 10/1/12). If a meeting lasted three days, each day should be listed separately on its own row. Do not include meeting dates on which all members “attended” by teleconference and did not involve travel.
  • In the second column, list the meeting location (e.g., Sacramento) for each date in the first column.
Section III.
  • In the first column, list the names of all committee/subcommittee members who attended one or more of the meetings listed in the first column of Section II. Do not list members who did not attend any meetings. List only one attendee per line. If a substitute attended any meeting, list the substitute’s name in this column too. Do not attach sign-in sheets in lieu of or in addition to listing the attendees.
  • In the second column, list the employer county for each attendee listed in the first column of this Section.

The table may be expanded and additional pages added to the form if necessary. If new information emerges following submittal of the Form J-4A, a new or corrected document clearly identified as "Revised" may be submitted.

Each CISC subcommittee lead should submit the completed Form J-4A to the CISC Chair in two forms: (1) signed, hard copy, and (2) electronic file sent as an e-mail attachment in excel format. The addresses are below:

Judy Flores, CISC Chair
Shasta County Office of Education
1644 Magnolia Avenue
Redding, CA 96001

Phone: 530-225-0211, E-mail:   

Section IV.
  • The CISC subcommittee lead signs for the subcommittee and the CISC Chair signs for the CISC committee, each attesting that the information reported in Sections II. and III. is complete and accurate.
Section V.
  • The CISC Chair signs in confirmation that the information reported in Section II. and III. of each Form J-4A is correct. The Chair then submits the final, confirmed Forms J-4A to CDE by August 26, 2013, in two formats as follows:

(1) In excel format, sent as an e-mail attachment to Tonya Holmes at

(2) The signed form which is either scanned, saved in pdf format, and sent as an e-mail attachment to Tonya Holmes at or sent in hard copy by U.S. mail to:

Tonya Holmes, Analyst
School Fiscal Services Division
California Department of Education
1430 N Street, Suite 3800
Sacramento, CA  95814-5901

Questions: Tonya Holmes | | 916-323-6028 
Last Reviewed: Tuesday, September 13, 2016
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