Department of Alcoholic Beverage Control State of California RESPONSIBLE BEVERAGE SERVICE TRAINING PROVIDER APPLICATION Submit completed application and support material (indexed and labeled in detail) to the Department of Alcoholic Beverage Control, RBS Training Provider Program, 3927 Lennane Drive, Suite 100, Sacramento, California 95834 A preliminary review of the application and support materials will be made, and if the program, as presented, meets the training level standards, a provisional approval will be given. Support material includes, but is not limited to: •Course Outline that identifies the page number where each curriculum standard is located. (For DVD’s, Power Point, etc. list specific reference, i.e., Scene number, Slide number, etc.) • Instruction Curriculum • Classroom Materials (including workbooks, DVD/videos, electronic presentations, examinations, handouts, etc.) • Completed Form ABC-802, Responsible Beverage Service Training Provider Summary, and supporting documents • Signed Authorization (On business letterhead authorizing the Department and the RBS Advisory Board to retain and utilize copyrighted material in order to review and evaluate applicant’s program for certification and future renewing of certification.) Upon a provisional approval, the RBS Project Coordinator will contact the Provider Applicant for an onsite review of the training program. After the on-site review, a full summary report will be submitted to the RBS Advisory Board for a final evaluation of the complete training program. Training programs passing the final evaluation will receive Certification. Please note: Support material will not be returned to applicant. The Department will retain and store the material for program reference. APPLICATION TYPE Original Program Change Renewal PROVIDER NAME (If individual: First Middle Last) BUSINESS PHONE NUMBER PROGRAM NAME FAX NUMBER BUSINESS ADDRESS (Street number and name, city, state, zip code) COUNTY WHERE BUSINESS IS LOCATED EMAIL ADDRESS MAILING ADDRESS (Street number and name, city, state, zip code) CONTACT NAME (First Middle Last) PHONE NUMBER EMAIL ADDRESS FAX NUMBER APPLICATION ENTITY GEOGRAPHICAL AREA SERVED Individual National Partnership Statewide Corporation Regional Trade Association County-wide: Other: City-wide: BUSINESS TYPE(S) TO RECEIVE TRAINING Bar Liquor Store County Fair Restaurant Supermarket Street Scene Convenience Store Winery TRAINING LEVEL Special Events PROGRAM WILL BE GIVEN TO (check ALL that apply) Level One (Basic Awareness) Internal Only Level Two (Professional Server) On-Sale Licensed Premises Employees Level Three (Manager) Off-Sale Licensed Premises Employees PERSON SUBMITTING APPLICATION (First Middle Last) PROGRAM HAS BEEN IN EXISTENCE FOR (Years and/or months) SIGNATURE DATE SIGNED ABC-801 (7/07) American LegalNet, Inc. www.FormsWorkflow.com