403(b) ENROLLMENT FORM

STEP 1 - PERSONAL INFORMATION (please print clearly)

NAME: ______SOCIAL SECURITY NUMBER: _ _ _ - _ _ - _ _ _ _

SCHOOL DISTRICT NAME: ______SCHOOL DISTRICT PLAN NUMBER: ______School district name and plan number list is provided at the back of this form.

DATE OF BIRTH: ______PHONE: ______ADDRESS: ______APT: ______CITY: ______STATE: ______ZIP CODE: ______EMAIL: ______

STEP 2 - CHOOSE YOUR INVESTMENT STRATEGY Please refer to the Plan Highlights and Fund Fact Sheets located at Pension2.com for additional information about the CalSTRS Pension2 Program, the Easy Choice Portfolios, Voya Fixed Plus III and the mutual fund investment options. The Investment Allocation of Contributions elected below will apply to all contribution sources. Eligibility to receive Employer Contributions under the plan is determined by the Employer. Completion of this Enrollment Form does not establish your eligibility to receive Employer Contributions. If you do not designate fund elections or elections do not total 100%, your investment allocation will default 100% to the Voya Fixed Plus III1. Please check only ONE of the two options below in this section: q ELECTION A - EASY CHOICE PORTFOLIO By selecting an Easy Choice Portfolio you are designating 100% of your contributions to that particular portfolio. You also agree to have your elections rebalanced periodically in order to stay within the investment percentages of the portfolio you have chosen. (The CalSTRS Pension2 Easy Choice Portfolios are created by CalSTRS from the list of investment options below, in conjunction with its Financial Planning Consultant.) If you would like to keep things simple, answer two questions. 1. When will you retire: (Check the box that best defines your expected retirement year) q 2060+ q 2050 q 2040 q 2030 q RETIRED 2. What type of investor are you: (Check the appropriate box) q CONSERVATIVE q MODERATE q AGGRESSIVE OR q ELECTION B - BUILD YOUR OWN PORTFOLIO If you prefer to choose among investments in different asset classes and develop your own portfolio to match your time horizon and tolerance for assuming risk, consider a “build your own portfolio” strategy. Allocations must equal 100%. If your selection is invalid or unclear, your contributions will be automatically invested for you in the Voya Fixed Plus III1.

VOYA FIXED PLUS III1 ______.00% VANGUARD SMALL CAP INDEX ______.00% FEDERATED US TREASURY CASH ______.00% VANGUARD MID CAP INDEX ______.00% VANGUARD TOTAL BOND MARKET ______.00% GMO GLOBAL EQUITY ASSET ______.00% VANGUARD SHORT-TERM BOND INDEX ______.00% VANGUARD EMERGING MARKETS ______.00% VANGUARD INFLATION PROTECTED ______.00% VANGUARD DEVELOPED MARKETS ______.00% VANGUARD TOTAL STOCK MARKET ______.00% DODGE AND COX INTERNATIONAL ______.00% VANGUARD INSTITUTIONAL INDEX PLUS ______.00% DFA INTERNATIONAL SMALL CO ______.00% NORTHERN GLOBAL SUSTAINABILITY INDEX ______.00% ARTISAN INTERNATIONAL ______.00% TIAA-CREF SOCIAL CHOICE EQUITY ______.00% VANGUARD REAL ESTATE INDEX INSTITUTIONAL ______.00% DODGE AND COX STOCK ______.00% PIMCO ALL ASSET ______.00% AMERICAN GROWTH FUND ______.00% Total Percent of Investment Allocation Must Equal 100%

1Voya Fixed Plus III is offered through a group annuity contract by Voya Retirement Insurance and Annuity Company, P.O. Box 990063, Hartford, CT 06199-0063

PAGE 1 of 6 CZ400CZ2ENROLLN 403(b) ENROLLMENT FORM

STEP 3 - START YOUR CONTRIBUTIONS

A Salary Reduction Agreement must be completed and submitted to your school district or your district’s third party administrator to start your contributions to Pension2. Please contact your school district (or, if applicable, your district’s third party administrator or 403bcompare.com) for the appropriate form(s). I understand that: • An election made on my 403(b) salary reduction agreement applies only to compensation paid or made available after the date that the 403(b) salary reduction agreement is signed. By completing this form you are directing CalSTRS to allocate funds to investment options offered by the CalSTRS Pension2 403(b) Program. All of your rights under these funding vehicles are subject to the terms of the CalSTRS Pension2 Program, your school district’s 403(b) plan, and the distribution restrictions under the Internal Revenue Code. CalSTRS may decide to cease offering any of these funding vehicles as allocation options under the plan and, should CalSTRS decide to do so, you may be required to transfer your accumulations in such plan funding option to another funding option. I have read and acknowledge all provisions to this form. I acknowledge that I have received and reviewed the Plan Highlights and Fund Fact Sheets located at Pension2.com which contain additional information about the CalSTRS Pension2 Program, the Easy Choice Portfolios, Voya Fixed Plus III and the mutual fund investment options. I certify under penalty of perjury under the laws of the State of that the Social Security number provided by me is my correct Social Security number.

PARTICIPANT’S SIGNATURE: ______DATE: _____/______/______The Information Practices Act of 1977 (Civil Code §1798.17) and the Federal Privacy Act of 1974 (Title 5, Code §552a(e)(3), §7 Note) require that this notice be provided when collecting personal information and Social Security numbers from individuals. Information requested on this form is used by CalSTRS, Active Financial Choices for the purposes of identification. Legal references authorizing solicitation and maintenance of this personal information include Education Code Sections 24950 and 24975, Government Code Sections 1151 and 1153, and Title 26, United States Code (Internal Revenue Code) Sections 6011 and 6051. It is mandatory to furnish all information requested on this form. Failure to provide the mandatory information may result in the enrollment action not being processed. Information requested on this form may be shared with the record-keeper, school district and school district’s contracted Third Party Administrator in conjuction with guidelines established by the Internal Revenue Service in accordance with 403(b) plans. Copies of the CalSTRS Pension2 Enrollment Form are maintained in confidential files of CalSTRS’ contracted supplemental savings plan administrator for five years. Enrollees have the right of access to their enrollment forms upon request. The agency official responsible for maintenance of the forms is: California State Teachers’ Retirement System, P.O. Box 15275 MS-44, Sacramento, CA 95851-0275.

Please submit your completed form to:

FAX DELIVERY: REGULAR MAIL DELIVERY: OVERNIGHT DELIVERY: CalSTRS Pension2 Plan Administration CalSTRS Pension2 Plan Administration CalSTRS Pension2 Plan Administration 1-888-814-5862 P.O. Box 389 One Orange Way Hartford, CT 06141 Windsor, CT 06095

If you have any questions, please contact a Customer Service Associate at (888) 394-2060 or go online at Pension2.com. Customer Service Associates are available Monday through Friday, 8:00 A.M. to 5:00 P.M. Pacific Time (excluding stock market holidays).

403(b) ENROLLMENT FORM / PAGE 2 of 6 403(b) ENROLLMENT FORM

CalSTRS PENSION2 SCHOOL DISTRICT PLAN NUMBERS Plan # School District Plan # School District Plan # School District Plan # School District 400396 ABC UNIFIED 400983 BELRIDGE ELEMENTARY 400651 CHAFFEY COMMUNITY COLLEGE DISTRICT 400928 DUARTE UNIFIED 400947 ACADEMIA SEMILLAS DEL PUEBLO 400802 BENICIA UNIFIED 400647 CHAFFEY JOINT UNION HIGH 400280 DUBLIN UNIFIED 400306 ACALANES UNION HIGH 400808 BENNETT VALLEY UNION ELEMENTARY 401059 CHARTER OAK UNIFIED 401125 DUNHAM ELEMENTARY 400476 ACCELERATED CHARTER 400278 BERKELEY UNIFIED 400694 CHARTER OF 401126 DUNSMUIR ELEMENTARY 400577 ACKERMAN ELEMENTARY 400746 BERRYESSA UNION ELEMENTARY 401060 CHATOM UNION ELEMENTARY 401127 DUNSMUIR JOINT UNION HIGH 400470 ACTON-AGUA DULCE UNIFIED 400405 BEVERLY HILLS UNIFIED 401061 CHAWANAKEE USD 401128 DURHAM UNIFIED 400627 ADELANTO ELEMENTARY 400986 BIG CREEK ELEMENTARY 401062 CHICAGO PARK ELEMENTARY 401850 E3 CIVIC HIGH 400276 ALAMEDA CITY UNIFIED 400987 BIG LAGOON UNION ELEMENTARY 400296 CHICO UNIFIED 401130 EAST NICOLAUS JOINT UNION HIGH 400948 ALAMEDA COUNTY OFFICE OF EDUCATION 400988 BIG OAK FLAT-GROVELAND UNIFIED 400632 CHINO VALLEY UNIFIED 401149 EAST PALO ALTO ACADEMY 400277 ALBANY UNIFIED 400990 BIG PINE UNIFIED 401065 CHOWCHILLA UNION HIGH 400419 EAST ROP 401955 ALBERT EINSTEIN ACADEMY 400991 BIG SPRINGS UNION ELEMENTARY 400517 CHUALAR UNION ELEMENTARY 400759 EAST SIDE UNION HIGH 400889 ALBOR CHARTER SCHOOL 400992 BIG VALLEY JOINT UNIFIED 400660 CHULA VISTA ELEMENTARY 400420 EAST WHITTIER ELEMENTARY 400949 ALEXANDER VALLEY UNION ELEMENTARY 400993 BIGGS UNIFIED 401066 CIENEGA UNION ELEMENTARY 400421 EASTSIDE UNION ELEMENTARY 400397 ALHAMBRA UNIFIED 401741 BIRMINGHAM COMMUNITY CHARTER 401067 CINNABAR ELEMENTARY 401134 EDISON CHARTER 400515 ALISAL UNION ELEMENTARY 400361 BISHOP UNION ELEM 400412 CITRUS COMMUNITY COLLEGE DISTRICT 400368 EDISON ELEMENTARY 400742 ALLAN HANCOCK JOINT COMMUNITY 400994 BITTERWATER-TULLY UNION ELEMENTARY 401890 CITRUS SPRINGS CHARTER SCHOOL 401930 EDUCATION FOR CHANGE COLLEGE DISTRICT 400786 BLACK BUTTE UNION ELEMENTARY 401881 CITY CHARTER SCHOOLS 401135 EDWARD B. COLE ACADEMY 401828 ALLIANCE ALMA 400995 BLAKE ELEMENTARY 400413 CLAREMONT UNIFIED 400422 EL CAMINO COMMUNITY CHARTER SCHOOL 401820 ALLIANCE BAXTER 400996 BLOCHMAN UNION ELEMENTARY 401069 CLASSICAL ACADEMY 401084 EL CAMINO REAL CHARTER HIGH 401838 ALLIANCE BLOOMFIELD 400997 BLUE LAKE UNION ELEMENTARY 401070 CLAY JOINT ELEMENTARY 400358 EL CENTRO ELEMENTARY 401819 ALLIANCE BURTON TECH 400998 BLUE OAK CHARTER 401206 CLAYTON VALLEY CHARTER HIGH SCHOOL 400423 EL MONTE CITY ELEMENTARY 401831 ALLIANCE COLLINS FAMILY 400999 BOGUS ELEMENTARY 400339 CLOVIS UNIFIED 400424 EL MONTE UNION HIGH 401823 ALLIANCE CRAHS 16 401000 BOLINAS-STINSON UNION 400592 UNIFIED 401137 EL NIDO ELEMENTARY 401825 ALLIANCE CRMA 12 400406 BONITA UNIFIED 400331 COALINGA/HURON JOINT UNIFIED 400425 EL RANCHO UNIFIED 401845 ALLIANCE CRMA 21 401001 BONNY DOON UNION ELEMENTARY 401074 COARSEGOLD UNION 400426 EL SEGUNDO UNIFIED 401826 ALLIANCE CRMA 4 401002 BONSALL UNION ELEMENTARY 400572 COAST COMMUNITY COLLEGE DISTRICT 401138 EL SOL SANTA ANA SCIENCE AND ARTS ACADEMY 401827 ALLIANCE CRMA 5 400689 BORREGO SPRINGS UNIFIED 400711 COAST UNIFIED 400385 EL TEJON UNIFIED 401829 ALLIANCE CRMA 8 401004 BRADLEY UNION ELEMENTARY 401076 COASTLINE ROP 401953 ELEMENT EDUCATION 401833 ALLIANCE ESAT 400355 BRAWLEY ELEMENTARY 401077 COFFEE CREEK ELEMENTARY 401141 ELK HILLS ELEMENTARY 401834 ALLIANCE GERTZ 401005 BRAWLEY UNION HIGH 401078 COLFAX ELEMENTARY 401142 ELKINS ELEMENTARY 401835 ALLIANCE HAS 400558 BREA OLINDA UNIFIED 401079 COLLEGE ELEMENTARY 400611 ELVERTA JOINT ELEMENTARY 401830 ALLIANCE KORY HUNTER 400312 BRENTWOOD UNION ELEMENTARY 401080 COLLEGE OF MARIN 401144 EMERY UNIFIED 401840 ALLIANCE LUSKIN 401007 BRIDGEVILLE ELEMENTARY 400633 COLTON JOINT UNIFIED 401891 EMPIRE SPRINGS CHARTER SCHOOL 401837 ALLIANCE MASS 401993 BRIDGES CHARTER SCHOOL 401081 COLTON REDLANDS YUCAIPA ROP 401146 EMPIRE UNION ELEMENTARY 401839 ALLIANCE MEDIA ARTS 401008 BRIGGS ELEMENTARY 401082 COLUMBIA ELEMENTARY 400662 ENCINITAS UNION ELEMENTARY 401832 ALLIANCE MOHAN 400715 BRISBANE ELEMENTARY 400857 COLUMBIA UNION 401147 ENTERPRISE ELEMENTARY 401824 ALLIANCE NEUWIRTH 401009 BRITTAN ELEMENTARY 400305 COLUSA COUNTY OFFICE OF EDUCATION 401148 ENVIRONMENTAL CHARTER HIGH SCHOOL 401844 ALLIANCE O’DONOVAN 401010 BROWNS ELEMENTARY 400304 COLUSA UNIFIED 400701 ESCALON UNIFIED 401821 ALLIANCE OUCHI 401012 BUELLTON UNION ELEMENTARY 401085 COMMUNITY CHARTER MIDDLE 400696 ESCONDIDO CHARTER HIGH 401841 ALLIANCE RICHARD MERKIN 400548 BUENA PARK ELEMENTARY 400414 COMPTON COMMUNITY COLLEGE DISTRICT 400663 ESCONDIDO UNION ELEMENTARY 401822 ALLIANCE SIMON TECH 400407 BURBANK UNIFIED 400415 COMPTON UNIFIED 400674 ESCONDIDO UNION HIGH 401836 ALLIANCE SKIRBALL 400716 BURLINGAME ELEMENTARY 400865 UNIFIED 401151 ESPARTO UNIFIED 401842 ALLIANCE SMIDT TECH 401014 BURNT RANCH ELEMENTARY 400839 CONNECTING WATERS CHARTER 400634 ETIWANDA ELEMENTARY 401843 ALLIANCE TENNENBAUM 401015 BURREL UNION ELEMENTARY 400321 CONTRA COSTA COMMUNITY COLLEGE DISTRICT 400346 EUREKA CITY UNIFIED 401804 ALMOND ACRES CHARTER SCHOOL 400301 BUTTE COMMUNITY COLLEGE DISTRICT 400314 CONTRA COSTA COUNTY OFFICE OF EDUCATION 400580 EUREKA UNION 400658 ALPINE UNION SCHOOL ELEMENTARY 400295 BUTTE COUNTY OFFICE OF EDUCATION 400656 COPPER MOUNTAIN COMMUNITY 400749 EVERGREEN ELEMENTARY (SANTA 400628 ALTA LOMA ELEMENTARY 401017 BUTTE VALLEY UNIFIED COLLEGE DISTRICT CLARA COUNTY) 400954 ALTA-DUTCH FLAT UNION ELEMENTARY 401018 BUTTEVILLE UNION ELEMENTARY 400873 CORE BUTTE CHARTER SCHOOL 401154 EVERGREEN UNION (TEHAMA COUNTY) 400745 ALUM ROCK UNION ELEMENTARY 401019 BUTTONWILLOW UNION ELEMENTARY 401088 CORNING UNION ELEMENTARY 401155 EXCELSIOR EDUCATION CENTER CHARTER 400957 ALVINA ELEMENTARY 401020 BYRON UNION ELEMENTARY 401089 CORNING UNION HIGH 400369 FAIRFAX ELEMENTARY 400925 ALVORD UNIFIED 400781 CABRILLO COMMUNITY COLLEGE DISTRICT 400679 CORONADO UNIFIED 400807 FAIRFIELD-SUISUN UNIFIED 400958 AMADOR COUNTY OFFICE OF EDUCATION 400732 CABRILLO UNIFIED 400593 CORONA-NORCO UNIFIED 401159 FALL RIVER JOINT UNIFIED 400294 AMADOR COUNTY UNIFIED 400659 CAJON VALLEY UNION ELEMENTARY 400822 COTATI-ROHNERT PARK UNIFIED 400664 FALLBROOK UNION ELEMENTARY 400547 ANAHEIM CITY SCHOOL DISTRICT 400356 CALEXICO UNIFIED 401091 COTTONWOOD UNION ELEMENTARY 400675 FALLBROOK UNION HIGH 400557 ANAHEIM UNION HIGH 401024 CALIENTE UNION ELEMENTARY 400416 COVINA-VALLEY UNIFIED 401161 FEATHER FALLS UNION ELEMENTARY 400783 ANDERSON UNION HIGH 402005 CALIFORNIA HERITAGE YOUTH BUILD ACADEMY 401093 CREAITVE ARTS CHARTER 401162 FEATHER RIVER COMMUNITY COLLEGE DISTRICT 400960 ANIMO INGLEWOOD CHARTER HIGH 401888 CALIFORNIA SCHOOL OF THE ARTS 401094 CRENSHAW ARTS-TECH CHARTER HIGH 401163 FENTON AVENUE CHARTER 400961 ANIMO LEADERSHIP HIGH CHARTER SAN GABRIEL VALLEY 401096 CUCAMONGA ELEMENTARY 400353 FERNDALE UNIFIED 400845 ANTELOPE ELEMENTARY 401030 CALIPATRIA UNIFIED 401097 CUDDEBACK UNION ELEMENTARY 401165 FIELDBROOK ELEMENTARY 400398 UNION HIGH 400536 CALISTOGA JOINT UNIFIED 401098 CULTURE AND LANGUAGE ACADEMY 401166 FILLMORE UNIFIED 400629 APPLE VALLEY UNIFIED 400747 CAMBRIAN OF SUCCESS 401167 FIREBAUGH-LAS DELTAS JOINT UNIFIED 400400 ARCADIA UNIFIED 400408 CAMINO NUEVO CHARTER 400417 CULVER CITY UNIFIED 401168 FIVE KEYS CHARTER (SF SHERIFF’S) 400962 ARCATA ELEMENTARY 400890 CAMPBELL UNION ELEMENTARY 400748 CUPERTINO UNION 401169 FLOURNOY UNION ELEMENTARY 400963 ARCOHE UNION ELEMENTARY 400758 CAMPBELL UNION HIGH 400858 CURTIS CREEK ELEMENTARY 400620 FOLSOM-CORDOVA UNIFIED 400388 ARMONA UNION ELEMENTARY 401036 CAMPTONVILLE ELEMENTARY 400887 CUTTEN ELEMENTARY 400635 FONTANA UNIFIED 400626 AROMAS/SAN JUAN UNIFIED 401038 CANYON ELEMENTARY 401101 CUYAMA JOINT UNIFIED 400764 FOOTHILL DE ANZA COMMUNITY 401170 ARTS IN ACTION COMMUNITY CHARTER 400559 CAPISTRANO UNIFIED 400938 CYPRESS ELEMENTARY COLLEGE DISTRICT 400968 ASPIRE PUBLIC SCHOOLS 401041 CAPISTRANO-LAGUNA BEACH ROP 401921 DA VINCI SCHOOLS 401171 FORESTHILL UNION ELEMENTARY 400970 ATASCADERO UNIFIED 401042 CAPITOL HEIGHTS ACADEMY 400872 DAVIS JOINT UNIFIED 400901 FORESTVILLE UNION ELEMENTARY 400971 ATWATER ELEMENTARY 400918 CARDIFF ELEMENTARY 401102 UNIFIED 401172 FORKS OF SALMON ELEMENTARY 400578 AUBURN UNION ELEMENTARY 400690 CARLSBAD UNIFIED 401103 DEHESA ELEMENTARY 401176 FORT SAGE UNIFIED 400973 AUDEO CHARTER 401043 CARMEL UNIFIED 400661 DEL MAR UNION 400881 FORTUNA UNION ELEMENTARY 400401 AZUSA UNIFIED 401045 CARUTHERS UNIFIED 400323 DEL NORTE COUNTY OFFICE OF EDUCATION 400347 FORTUNA UNION HIGH 400974 BAKER VALLEY UNIFIED 401048 CASCADE UNION ELEMENTARY 400322 DEL NORTE COUNTY UNIFIED 400926 FOUNTAIN VALLEY ELEMENTARY 400365 BAKERSFIELD CITY SCHOOL DISTRICT 400409 CASTAIC UNION ELEMENTARY 400897 DELANO JOINT UNION HIGH 400905 FOWLER UNIFIED 400402 BALDWIN PARK UNIFIED 401050 CASTLE ROCK UNION ELEMENTARY 400367 DELANO UNION ELEMENTARY 401177 FRANKLIN ELEMENTARY 400648 BALDY VIEW ROP 400279 CASTRO VALLEY UNIFIED 401106 DELHI ELEMENTARY 400750 FRANKLIN-MCKINLEY ELEMENTARY 400506 BALLICO-CRESSEY ELEMENTARY 400709 CAYUCOS ELEMENTARY 401107 DELPHIC ELEMENTARY 400760 FREMONT UNION HIGH 400975 BANGOR UNION ELEMENTARY 401815 CEIBA PUBLIC SCHOOLS 401110 DENAIR UNIFIED 401180 FRENCH GULCH-WHISKEYTOWN ELEMENTARY 400590 BANNING UNIFIED 400610 CENTER JOINT UNIFIED 401111 DESERT CENTER UNIFIED 401181 FRESHWATER ELEMENTARY 400976 BANTA ELEMENTARY 400410 CENTINELA VALLEY UNION HIGH 400587 DESERT COMMUNITY COLLEGE DISTRICT 400330 FRESNO COUNTY OFFICE OF EDUCATION 400650 BARSTOW COMMUNITY COLLEGE DISTRICT 401051 CENTRAL CITY VALUE 401112 DESERT SANDS CHARTER HIGH SCHOOL 400340 FRESNO UNIFIED 400630 BARSTOW UNIFIED 400763 CENTRAL COUNTY ROP 400594 DESERT SANDS UNIFIED 400370 FRUITVALE ELEMENTARY 400403 BASSETT UNIFIED 400631 CENTRAL ELEMENTARY 401113 DI GIORGIO ELEMENTARY 400550 FULLERTON ELEMENTARY 400713 BAYSHORE ELEMENTARY 401054 CENTRAL SIERRA ROP 401239 DIABLO VALLEY COMMUNITY COLLEGE DISTRICT 400560 FULLERTON JOINT UNION HIGH 400981 BEAR VALLEY UNIFIED 400333 CENTRAL UNIFIED 401117 DISCOVERY CHARTER 401854 GABRIELLA CHARTER 400366 BEARDSLEY ELEMENTARY 400357 CENTRAL UNION HIGH 401118 DIXIE ELEMENTARY 400612 GALT JOINT UNION ELEMENTARY 400591 BEAUMONT UNIFIED 401056 CENTRAL VALLEY PRESCHOOL JPA 400803 DIXON UNIFIED 400616 GALT JOINT UNION HIGH 400785 BELLA VISTA ELEMENTARY 400549 CENTRALIA ELEMENTARY 401122 DOS PALOS-ORO LOMA JOINT UNIFIED 400561 GARDEN GROVE UNIFIED 400982 BELLEVIEW ELEMENTARY 401057 CERES UNIFIED 401123 DOUGLAS CITY ELEMENTARY 401185 GARFIELD CHARTER 400896 BELLEVUE UNION ELEMENTARY 400411 CERRITOS COMMUNITY COLLEGE DISTRICT 400418 DOWNEY UNIFIED 400348 GARFIELD ELEMENTARY 400404 BELLFLOWER UNIFIED 400292 CHABOT-LAS POSITAS COMMUNITY 401191 DOWNTOWN COLLEGE PREP 400427 GARVEY ELEMENTARY 400714 BELMONT-REDWOOD SHORES ELEMENTARY COLLEGE DISTRICT 400579 DRY CREEK JOINT ELEMENTARY 401186 GATEWAY HIGH CHARTER 403(b) ENROLLMENT FORM / PAGE 3 of 6 403(b) ENROLLMENT FORM Plan # School District Plan # School District Plan # School District Plan # School District 400782 GATEWAY UNIFIED 400316 JOHN SWETT UNIFIED 400363 LONE PINE UNIFIED 400451 MOUNTAIN VIEW ELEMENTARY 400765 GAVILAN JOINT COMMUNITY COLLEGE DISTRICT 401252 JOHNSTONVILLE ELEMENTARY 400444 LONG BEACH COMMUNITY COLLEGE DISTRICT ( COUNTY) 401188 GAZELLE UNION ELEMENTARY 401253 JULIAN CHARTER 400443 LONG BEACH UNIFIED 400638 MOUNTAIN VIEW ELEMENTARY (SAN 401189 GENERAL SHAFTER ELEMENTARY 400666 JULIAN UNION ELEMENTARY 401323 LONG VALLEY CHARTER BERNARDINO COUNTY) 401190 GERBER UNION ELEMENTARY 401254 JULIAN UNION HIGH 401324 LOOMIS UNION ELEMENTARY 400754 MOUNTAIN VIEW WHISMAN 400823 GEYSERVILLE UNIFIED 401256 JUNCTION CITY ELEMENTARY 400565 LOS ALAMITOS UNIFIED 400762 MOUNTAIN VIEW-LOS ALTOS UNION HIGH 400770 GILROY UNIFIED 400788 JUNCTION ELEMENTARY (SHASTA COUNTY) 400751 LOS ALTOS ELEMENTARY 401397 MT. BALDY JOINT ELEMENTARY 400429 GLENDALE COMMUNITY COLLEGE DISTRICT 401257 JUNCTION ELEMENTARY (SISIKYOU COUNTY) 400546 LOS ANGELES CONSERVATION CORPS CHARTER 400317 MT. DIABLO UNIFIED 400430 GLENDORA UNIFIED 400598 JURUPA UNIFIED 400485 LOS ANGELES COUNTY OFFICE OF EDUCATION 401398 MT. PLEASANT ELEMENTARY 401195 GOLD RUSH CHARTER 401258 KASHIA ELEMENTARY 400877 LOS ANGELES UNIFIED 400450 MT. SAN ANTONIO COMMUNITY 401197 GOLDEN FEATHER UNION ELEMENTARY 402010 KEILLER LEADERSHIP ACADEMY 400508 LOS BANOS UNIFIED COLLEGE DISTRICT 401182 GOLDEN OAK MONTESSORI OF HAYWARD 401259 KELSEYVILLE UNIFIED 401328 LOS GATOS UNION ELEMENTARY 400588 MT. SAN JACINTO COMMUNITY 401073 GOLDEN VALLEY CHARTER 401260 KENTFIELD ELEMENTARY 400761 LOS GATOS-SARATOGA JOINT UNION HIGH COLLEGE DISTRICT 401960 GOLDEN VALLEY CHARTER - VENTURA 400893 KENWOOD ELEMENTARY 401330 LOS MOLINOS UNIFIED 400796 MT. SHASTA UNION ELEMENTARY 400906 GOLDEN VALLEY UNIFIED 400435 KEPPEL UNION SCHOOL DISTRICT 400445 LOS NIETOS 400545 MUIR CHARTER 400518 GONZALES UNIFIED 401263 KERMAN UNIFIED 400618 LOS RIOS COMMUNITY COLLEGE DISTRICT 401400 MULBERRY ELEMENTARY 401200 GORMAN ELEMENTARY 400382 KERN COMMUNITY COLLEGE DISTRICT 401332 LOST HILLS UNION ELEMENTARY 400891 MULTICULTURAL LEARNING CENTER 400431 GORMAN LEARNNG CENTER 400384 KERN COUNTY OFFICE OF EDUCATION 400929 LOWELL JOINT ELEMENTARY 401401 MUPU ELEMENTARY 400460 GRANADA HILLS CHARTER HIGH 400378 KERN UNION HIGH 401333 LUCERNE VALLEY UNIFIED 401402 MUROC JOINT UNIFIED 400787 GRANT ELEMENTARY 401265 KERNVILLE UNION ELEMENTARY 401334 LUCIA MAR UNIFIED 400601 MURRIETA VALLEY UNIFIED 400542 GRASS VALLEY ELEMENTARY 401267 KEYES UNION 401335 LUTHER BURBANK 400538 NAPA COUNTY OFFICE OF EDUCATION 401202 GRATTON ELEMENTARY 401268 KID STREET LEARNING CENTER CHARTER 400446 LYNWOOD UNIFIED 400537 NAPA VALLEY COMMUNITY COLLEGE DISTRICT 401203 GRAVENSTEIN UNION ELEMENTARY 400521 KING CITY UNION ELEM 401337 MAGNOLIA ELEMENTARY (ORANGE COUNTY) 400539 NAPA VALLEY UNIFIED 401204 GRAVES ELEMENTARY 401136 KING-CHAVEZ ACADEMY OF EXCELLENCE 400447 MANHATTAN BEACH UNIFIED 400936 NATIONAL ELEMENTARY 401205 GREEN POINT ELEMENTARY 400335 KINGS CANYON JOINT UNIFIED 400705 MANTECA UNIFIED 401264 NATIONAL UNIVERSITY OF HEALTH SCIENCES 400371 GREENFIELD UNION (KERN COUNTY) 401271 KINGS RIVER-HARDWICK UNION ELEMENTARY 400298 MANZANITA ELEMENTARY 400639 NEEDLES UNIFIED 400519 GREENFIELD UNION ELEMENTARY 401813 KINGSBURG JOINT ELEMENTARY 401341 MAPLE CREEK ELEMENTARY 401405 NEVADA CITY ELEMENTARY (MONTEREY COUNTY) SCHOOL DISTRICT 401342 MAPLE ELEMENTARY 401408 NEVADA COUNTY OFFICE OF EDUCATION 400793 GRENADA ELEMENTARY 401272 KINGSBURG JOINT UNION ELEMENTARY 401343 MARCUM-ILLINOIS UNION ELEMENTARY 401407 NEVADA COUNTY SPECIAL EDUCATION 400297 GRIDLEY UNIFIED 400942 KINGSBURG JOINT UNION HIGH 401811 MARE ISLAND TECHNOLOGY ACADEMY 401409 NEVADA JOINT UNION HIGH 401209 GRIZZLY CHALLENGE CHARTER 401273 KIRKWOOD ELEMENTARY 401344 MARICOPA UNIFIED 401410 NEW CITY 400676 GROSSMONT UNION HIGH 400795 KLAMATH RIVER UNION ELEMENTARY 400497 MARIN COUNTY OFFICE OF EDUCATION 400285 NEW HAVEN UNIFIED 400684 GROSSMONT-CUYAMACA COMMUNITY 400350 KLAMATH-TRINITY JOINT UNIFIED 401347 MARIPOSA COUNTY OFFICE OF EDUCATION 401412 NEW HOPE ELEMENTARY COLLEGE DISTRICT 401275 KNEELAND ELEMENTARY 401348 MARIPOSA COUNTY UNIFIED 401413 NEW JERUSALEM ELEMENTARY 401210 GUADALUPE UNION ELEMENTARY 401276 KNIGHTS FERRY ELEMENTARY 400813 MARK WEST UNION ELEMENTARY 401414 NEW WEST CHARTER MIDDLE SCHOOL 400695 GUAJOME PARK ACADEMY CHARTER 401277 KNIGHTSEN ELEMENTARY 401350 MARTINEZ UNIFIED 400284 NEWARK UNIFIED 401211 GUIDANCE CHARTER 400390 KONOCTI UNIFIED 400875 MARYSVILLE JOINT UNIFIED 401415 NEWCASTLE ELEMENTARY 401212 GUSTINE UNIFIED 400436 LA CANADA UNIFIED 400354 MATTOLE UNIFIED 400452 NEWHALL ELEMENTARY 400432 HACIENDA LA PUENTE UNIFIED 400552 LA HABRA CITY ELEMENTARY 401351 MAXWELL UNIFIED 400830 NEWMAN-CROWS LANDING UNIFIED 400794 HAPPY CAMP UNION ELEMENTARY 400668 LA MESA-SPRING VALLEY 401352 MCCABE UNION ELEMENTARY 400566 NEWPORT-MESA UNIFIED 401216 HAPPY VALLEY ELEMENTARY (SANTA 400438 LA PUENTE VALLEY ROP 401353 MCCLOUD UNION ELEMENTARY 401417 NICASIO CRUZ COUNTY) 400307 LAFAYETTE ELEMENTARY 400387 MCFARLAND UNIFIED 400374 NORRIS ELEMENTARY 401217 HAPPY VALLEY UNION ELEMENTARY 400564 LAGUNA BEACH UNIFIED 400351 MCKINLEYVILLE UNION ELEMENTARY 401418 NORTH COUNTY JOINT UNION ELEMENTARY (SHASTA COUNTY) 401280 LAGUNA JOINT ELEMENTARY 401355 MCKITTRICK ELEMENTARY 400922 NORTH COW CREEK ELEMENTARY 401892 HARBOR SPRINGS CHARTER SCHOOL 401281 LAGUNITA ELEMENTARY 401356 MCSWAIN UNION ELEMENTARY 401419 NORTH KERN VOCATIONAL TRAINING CENTER 400811 HARMONY UNION ELEMENTARY 401282 LAGUNITAS ELEMENTARY 401357 MEADOWS UNION ELEMENTARY 400525 NORTH MONTEREY COUNTY UNIFIED 400520 HARTNELL COMMUNITY COLLEGE DISTRICT 400395 LAKE COUNTY OFFICE OF EDUCATION 401359 MENDOCINO COUNTY YOUTH PROJECT 401420 NORTH OAKLAND COMMUNITY CHARTER 401218 HART-RANSOM UNION ELEMENTARY 400595 LAKE ELSINORE UNIFIED 400336 MENDOTA UNIFIED 400884 NORTH ORANGE COUNTY COMMUNITY 401889 HAWKING STEAM CHARTER SCHOOL 400391 LAKEPORT UNIFIED 400599 MENIFEE UNION ELEMENTARY COLLEGE DISTRICT 400433 HAWTHORNE SCHOOL DISTRICT 401287 LAKESIDE JOINT (SANTA CLARA COUNTY) 400721 MENLO PARK CITY ELEMENTARY 400574 NORTH ORANGE COUNTY ROP 400282 HAYWARD UNIFIED 400667 LAKESIDE UNION ELEMEMTARY 400509 MERCED CITY ELEMENTARY 400345 NORTHERN HUMBOLDT UNION HIGH 400892 HEALDSBURG UNIFIED (SAN DIEGO COUNTY) 400512 MERCED COMMUNITY COLLEGE DISTRICT 400453 NORWALK-LA MIRADA UNIFIED 401221 HEBER ELEMENTARY 400372 LAKESIDE UNION SCHOOL DISTRICT 401361 MERCED COUNTY MIGRANT EDUCATION 400493 NOVATO UNIFIED 401222 HELENDALE ELEMENTARY (KERN COUNTY) 401362 MERCED COUNTY OFFICE OF EDUCATION 401421 NUESTRO ELEMENTARY 401783 HELIX CHARTER SCHOOL 401289 LAMMERSVILLE UNIFIED 401363 MERCED RIVER UNION ELEMENTARY 401422 NUEVA ESPERANZA CHARTER 400596 HEMET UNIFIED 400373 LAMONT ELEMENTARY 400511 MERCED UNION HIGH 401423 NUVIEW UNION 401225 HERITAGE K-8 CHARTER 400437 LANCASTER ELEMENTARY 401364 MERIDIAN ELEMENTARY 400755 OAK GROVE ELEMENTARY (SANTA CLARA 401226 HERMOSA BEACH CITY ELEMENTARY 400490 LARKSPUR-CORTE MADERA SCHOOL DISTRICT 401365 MESA UNION ELEMENTARY COUNTY) 400636 HESPERIA UNIFIED 401291 LAS FAMILIAS DEL PUEBLO VALUE CHARTER 401075 METROPOLITAN EDUCATION DISTRICT ROP 401425 OAK GROVE UNION ELEMENTARY (SONOMA 400829 HICKMAN ELEMENTARY 400720 LAS LOMITAS ELEMENTARY 400392 MIDDLETOWN UNIFIED COUNTY) 401904 HIGH TECH HIGH 400439 LAS VIRGENES UNIFIED 401366 MIDWAY ELEMENTARY 400868 OAK PARK UNIFIED 400717 HILLSBOROUGH CITY ELEMENTARY 401292 LASSEN COMMUNITY COLLEGE DISTRICT 401367 MILL VALLEY ELEMENTARY 401426 OAK RUN ELEMENTARY 401227 HILMAR UNIFIED 401293 LASSEN COUNTY OFFICE OF EDUCATION 400722 MILLBRAE ELEMENTARY 401428 OAK VIEW UNION ELEMENTARY 400624 HOLLISTER SCHOOL DISTRICT 401295 LASSEN ROP 401368 MILLVILLE ELEMENTARY 401429 OAKDALE JOINT UNIFIED 400359 HOLTVILLE UNIFIED 401296 LASSEN UNION HIGH 400772 MILPITAS UNIFIED 400313 OAKLEY UNION ELEMENTARY 401976 HOMETECH CHARTER SCHOOL 401297 LASSEN VIEW UNION ELEMENTARY 400685 MIRACOSTA COMMUNITY COLLEGE DISTRICT 401432 OASIS CHARTER PUBLIC 400585 HORIZON CHARTER 401298 LATON JOINT UNIFIED 401372 MISSION UNION ELEMENTARY 400912 OCEAN GROVER CHARTER 401232 HORNBROOK ELEMENTARY 401300 LAYTONVILLE UNIFIED 400837 MODESTO CITY SCHOOLS 400553 OCEAN VIEW (ORANGE COUNTY) 401235 HOWELL MOUNTAIN ELEMENTARY 400440 LAWNDALE ELEMENTARY 401374 MODOC COUNTY OFFICE OF EDUCATION 401433 OCEAN VIEW (VENTURA COUNTY) 400861 HUENEME ELEMENTARY 401301 LE GRAND UNION ELEMENTARY 401376 MODOC JOINT UNIFIED 400691 OCEANSIDE UNIFIED 401236 HUGHES-ELIZABETH LAKES UNION ELEMENTARY 401302 LE GRAND UNION HIGH 400379 MOJAVE UNIFIED 401434 ODYSSEY CHARTER 401237 HUGHSON UNION 401303 LEADERSHIP HIGH 401378 MONO COUNTY SCHOOLS COMMUNITY LIBRARY 401435 OHLONE COMMUNITY COLLEGE DISTRICT 400344 HUMBOLDT COUNTY OFFICE OF EDUCATION 401304 LEADERSHIP PUBLIC SCHOOLS: RICHMOND 401380 MONROE ELEMENTARY 401436 OJAI UNIFIED 400551 HUNTINGTON BEACH ELEMENTARY 400669 LEMON GROVE ELEMENTARY 400448 MONROVIA UNIFIED 400640 ONTARIO-MONTCLAIR ELEMENTARY 400562 HUNTINGTON BEACH UNION HIGH 401931 LENNOX ACADEMY MATH, SCIENCE AND 401382 MONTAGUE CHARTER ACADEMY 401439 ORANGE CENTER ELEMENTARY 401240 HYDESVILLE ELEMENTARY TECHNOLOGY 401383 MONTAGUE ELEMENTARY 400575 ORANGE COUNTY OFFICE OF EDUCATION 401248 ICEF CHARTER ACADEMY 400441 LENNOX ELEMENTARY 401384 MONTE RIO UNION ELEMENTARY 400555 ORANGE COUNTY SCHOOL OF THE ARTS 401241 IGO, ONO, PLATINA UNION ELEMENTARY 401927 LEWIS CENTER FOR EDUCATIONAL RESEARCH 400449 MONTEBELLO UNIFIED 400567 ORANGE UNIFIED 400920 CCD 401310 LEWISTON ELEMENTARY 400738 MONTECITO UNION ELEMENTARY 401441 ORCHARD ELEMENTARY 401242 IMPERIAL COUNTY OFFICE OF EDUCATION 401312 LIBERTY ELEMENTARY (TULARE COUNTY) 400535 MONTEREY COUNTY OFFICE OF EDUCATION 400739 ORCUTT UNION ELEMENTARY 400360 IMPERIAL UNIFIED 400311 LIBERTY UNION HIGH 400524 MONTEREY PENINSULA COMMUNITY 401442 ORICK ELEMENTARY 401244 IMPERIAL VALLEY ROP 401314 LINCOLN ELEMENTARY COLLEGE DISTRICT 400309 ORINDA UNION ELEMENTARY 401246 INDIAN SPRINGS ELEMENTARY 400703 LINCOLN UNIFIED 400523 MONTEREY PENINSULA UNIFIED 401444 ORO GRANDE ELEMENTARY 400434 INGLEWOOD UNIFIED 401315 LINDEN UNIFIED 400921 MONTGOMERY ELEMENTARY 401445 OROVILLE ADULT EDUCATION 401946 INTEGRITY CHARTER SCHOOL 401316 LINNS VALLEY-POSO FLAT UNION SD 400869 MOORPARK UNIFIED 400299 OROVILLE CITY ELEMENTARY 400364 INYO COUNTY OFFICE OF EDUCATION 401317 LITERACY FIRST CHARTER 400308 MORAGA ELEMENTARY 401446 OROVILLE UNION HIGH 400563 IRVINE UNIFIED 400442 LITTLE LAKE CITY ELEMEMENTARY 401387 MORELAND ELEMENTARY 401448 UNIFIED 400349 JACOBY CREEK ELEMENTARY 401318 LITTLE SHASTA ELEMENTARY 400600 MORENO VALLEY UNIFIED 400862 OXNARD ELEMENTARY 400859 JAMESTOWN ELEMENTARY 400775 LIVE OAK ELEMENTARY 400771 MORGAN HILL UNIFIED 400864 OXNARD UNION HIGH 400665 JAMUL-DULZURA UNION ELEMENTARY 400841 LIVE OAK UNIFIED 400637 MORONGO UNIFIED 400789 PACHECO UNION ELEMENTARY 401250 JANESVILLE UNION ELEMENTARY 400283 LIVERMORE VALLEY JOINT UNIFIED 401390 MOUNTAIN ELEMENTARY 401849 PACIFIC COLLEGIATE CHARTER SCHOOL 401251 JEFFERSON ELEMENTARY (SAN BENITO COUNTY) 400507 LIVINGSTON UNION ELEMENTARY 401391 MOUNTAIN EMPIRE UNIFIED 401449 PACIFIC ELEMENTARY 400702 JEFFERSON ELEMENTARY (SAN JOAQUIN COUNTY) 400704 LODI UNIFIED 401392 MOUNTAIN HOUSE ELEMENTARY 400526 PACIFIC GROVE UNIFIED 400718 JEFFERSON ELEMENTARY (SAN MATEO COUNTY) 401320 LOLETA UNION ELEMENTARY 401393 MOUNTAIN UNION ELEMENTARY 401451 PACIFIC UNION ELEMENTARY (FRESNO COUNTY) 400728 JEFFERSON UNION HIGH 401321 LOMA PRIETA JOINT UNION ELEMENTARY 401394 MOUNTAIN VALLEY UNIFIED 401452 PACIFIC UNION ELEMENTARY (HUMBOLDT 401799 JOHN MUIR CHARTER SCHOOL 401322 LOMPOC UNIFIED COUNTY)

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Plan # School District Plan # School District Plan # School District Plan # School District 401945 PACOIMA CHARTER ELEMENTARY 400605 RIVERSIDE UNIFIED 401568 UNION HIGH 400678 SWEETWATER UNION HIGH 401453 PACIFICA 401527 ROBERTS FERRY UNION ELEMENTARY 400670 SANTEE ELEMENTARY 400833 SYLVAN UNION ELEMENTARY 400780 PAJARO VALLEY UNIFIED 401528 ROBLA ELEMENTARY 401569 SARATOGA UNION ELEMENTARY 400475 SYNERGY CHARTER ACADEMY 401454 PALERMO UNION ELEMENTARY 400586 ROCKLIN ACADEMY 400469 SAUGUS UNION ELEMENTARY 401641 TAFT CITY SCHOOL DISTRICT 400471 PALISADES CHARTER HIGH 400582 ROCKLIN UNIFIED 401571 SAUSALITO MARIN CITY 400899 TAFT UNION HIGH 400602 PALM SPRINGS UNIFIED 401530 ROMOLAND ELEMENTARY 400554 SAVANNA ELEMENTARY 401642 TAHOE-TRUCKEE UNIFIED 401876 PALMDALE AEROSPACE ACADEMY 400375 ROSEDALE UNION ELEMENTARY 401573 SCHOOL OF ARTS AND ENTERPRISE 400495 TAMALPAIS UNION HIGH 400454 PALMDALE ELEMENTARY 400817 ROSELAND ELEMENTARY 401574 SCOTIA UNION ELEMENTARY 400381 TEHACHAPI UNIFIED 400768 PALO ALTO UNIFIED 400462 ROSEMEAD ELEMENTARY 401283 SCOTT VALLEY UNIFIED (SISKIYOU COUNTY) 400844 TEHAMA COUNTY OFFICE OF EDUCATION 401456 PALO VERDE COMMUNITY COLLEGE DISTRICT 400583 ROSEVILLE CITY ELEMENTARY 400776 SCOTTS VALLEY UNIFIED (SANTA CRUZ COUNTY) 401644 TEMECULA VALLEY CHARTER 401457 PALO VERDE UNIFIED 400885 ROSEVILLE JOINT UNION HIGH 401576 SEELEY UNION ELEMENTARY 400607 TEMECULA VALLEY UNIFIED 401458 PALO VERDE UNION ELEMENTARY 401531 ROSS ELEMENTARY 401577 SEIAD ELEMENTARY 400904 TEMPLE CITY UNIFIED 400683 PALOMAR COMMUNITY COLLEGE DISTRICT 400496 ROSS VALLEY ELEMENTARY 400908 SELMA UNIFIED 401646 TEMPLETON UNIFIED 400455 UNIFIED 401532 ROUND VALLEY JOINT ELEMENTARY 401578 SEMITROPIC ELEMENTARY 401648 THERMALITO UNION ELEMENTARY 400914 PANAMA-BUENA VISTA UNION SD 400463 ROWLAND UNIFIED 400730 SEQUOIA UNION HIGH 401942 THRIVE PUBLIC SCHOOLS 401459 PANOCHE ELEMENTARY 400621 SACRAMENTO CITY UNIFIED 401580 SHAFFER UNION ELEMENTARY 400477 TORRANCE UNIFIED 401460 PARADISE ADULT 400623 SACRAMENTO COUNTY OFFICE OF EDUCATION 401581 SHANDON JOINT UNIFIED 400700 TRACY JOINT UNIFIED 401461 PARADISE ELEMENTARY 400569 SADDLEBACK VALLEY UNIFIED 401584 SHASTA COUNTY OFFICE OF EDUCATION 400805 TRAVIS UNIFIED 400300 PARADISE UNIFIED 400541 SAINT HELENA UNIFIED 401586 SHASTA UNION ELEMENTARY 401656 TREE OF LIFE CHARTER 401035 PARAMOUNT ACADEMY 401535 SALIDA UNION ELEMENTARY 401587 SHASTA UNION HIGH 401657 TRES PINOS UNION ELEMENTARY 400935 PARAMOUNT UNIFIED 400527 SALINAS CITY ELEMENTARY 400784 SHASTA-TEHEMA-TRINITY JOINT COMMUNITY 401658 TRI-CITIES ROP 401462 PARLIER UNIFIED 400528 SALINAS UNION HIGH COLLEGE DISTRICT 401659 TRINIDAD UNION ELEMENTARY 400456 PASADENA AREA COMMUNITY COLLEGE 400529 SAN ANTONIO UNION ELEMENTARY 401588 SHASTA-TRINITY ROP 401660 TRINITY CENTER ELEMENTARY DISTRICT 401536 SAN ARDO UNION ELEMENTARY 401590 SHILOH ELEMENTARY 400848 TRINITY COUNTY OFFICE OF EDUCATION 400457 PASADENA UNIFIED 401560 SANTA BARBARA UNIFIED 400492 SHORELINE UNIFIED 400989 TRI-VALLEY ROP 401464 PASO ROBLES JOINT UNIFIED 401537 SAN BENITO COUNTY OFFICE OF EDUCATION 401784 SIATECH CHARTER SCHOOL 401663 TRONA JOINT UNIFIED 401465 PATHWAYS CHARTER 400625 SAN BENITO HIGH 401591 SIERRA CHARTER 400931 TULELAKE BASIN JOINT UNIFIED 400832 PATTERSON JOINT UNIFIED 400655 SAN BERNARDINO CITY UNIFIED 401592 SIERRA COUNTY OFFICE OF EDUCATION 400860 TUOLUMNE COUNTY OFFICE OF EDUCATION 401022 PEABODY CHARTER 400652 SAN BERNARDINO COMMUNITY COLLEGE 401594 SIERRA JOINT COMMUNITY COLLEGE DISTRICT 400835 TURLOCK UNIFIED 401467 PENINSULA UNION ELEMENTARY DISTRICT 401853 SIERRA FOOTHILL CHARTER SCHOOL 400571 TUSTIN UNIFIED 400291 PERALTA COMMUNITY COLLEGE DISTRICT 400657 SAN BERNARDINO COUNTY OFFICE OF 400386 SIERRA SANDS UNIFIED 400933 TWAIN HARTE-LONG BARN UNION ELEMENTARY 400603 PERRIS ELEMENTARY EDUCATION 400338 SIERRA UNIFIED 401669 TWIN HILLS UNION ELEMENTARY 400604 PERRIS UNION HIGH 400725 SAN BRUNO PARK ELEMENTARY 400791 SIERRA-PLUMAS JOINT UNIFIED 400944 TWIN RIVERS UNIFIED 400287 PIEDMONT CITY UNIFIED 401058 SAN CARLOS CHARTER LEARNING CENTER 401851 SILVER OAK HIGH SCHOOL 401670 TWO ROCK UNION 401470 PIERCE JOINT UNIFIED 400726 SAN CARLOS ELEMENTARY 400643 SILVER VALLEY UNIFIED 400757 UNION ELEMENTARY 401471 PINE RIDGE ELEMENTARY 400687 SAN DIEGO COMMUNITY COLLEGE DISTRICT 400866 UNIFIED 401672 UNION HILL ELEMENTARY 400815 PINER-OLIVET CHARTER 400697 SAN DIEGO COUNTY OFFICE OF EDUCATION 401598 SISKIYOU COUNTY OFFICE OF EDUCATION 401673 UNION JOINT ELEMENTARY 400814 PINER-OLIVET UNION ELEMENTARY 400681 SAN DIEGO UNIFIED 400798 SISKIYOU JOINT COMMUNITY COLLEGE DISTRICT 401674 UNIVERSITY CHARTER 401472 PIONEER UNION ELEMENTARY (BUTTE COUNTY) 400699 COUNTY OFFICE OF EDUCATION 400797 SISKIYOU UNION HIGH 401798 UNIVERSITY PREPARATION SCHOOL AT 400318 PITTSBURG UNIFIED 400698 SAN FRANCISCO UNIFIED 400915 SKY MOUNTAIN CHARTER CSU CHANNEL ISLANDS (CSUCI) 400568 PLACENTIA-YORBA LINDA UNIFIED 401923 SAN DIEGO VIRTUAL SCHOOL 401601 SNELLING-MERCED FALLS UNION ELEMENTARY 400645 UPLAND UNIFIED 400932 PLACER COUNTY OFFICE OF EDUCATION 400464 SAN GABRIEL UNIFIED 400895 SNOWLINE JOINT UNIFIED 401675 UPPER LAKE UNION ELEMENTARY 400581 PLACER HILLS UNION ELEMENTARY 400606 SAN JACINTO UNIFIED 400672 SOLANA BEACH ELEMENTARY 400394 UPPER LAKE UNION HIGH 400584 PLACER UNION HIGH 401544 SAN JACINTO VALLEY ACADEMY CHARTER 400801 SOLANO COMMUNITY COLLEGE DISTRICT 401956 URBAN DISCOVERY ACADEMY CHARTER 401476 PLAINSBURG UNION ELEMENTARY 400708 SAN JOAQUIN COUNTY OFFICE OF EDUCATION 400800 SOLANO COUNTY OFFICE OF EDUCATION 400806 VACAVILLE UNIFIED 401477 PLANADA ELEMENTARY 400706 SAN JOAQUIN DELTA COMMUNITY COLLEGE 401603 SOLEDAD ENRICHMENT CENTER 400608 VAL VERDE UNIFIED 401479 PLEASANT GROVE JOINT UNION DISTRICT 400531 SOLEDAD UNIFIED 400902 VALLE LINDO ELEMENTARY 400543 PLEASANT RIDGE UNION ELEMENTARY 401219 SAN JOSE CHARTER ACADEMY 401605 SOLVANG ELEMENTARY 401681 VALLECITOS ELEMENTARY (SAN DIEGO COUNTY) 401480 PLEASANT VALLEY (VENTURA COUNTY) 400769 SAN JOSE UNIFIED 401606 SOMIS UNION 400804 VALLEJO CITY UNIFIED 401482 PLEASANT VALLEY JOINT UNION ELEMENTARY 400767 SAN JOSE/EVERGREEN COMMUNITY COLLEGE 401607 SONOMA CHARTER 401683 VALLEY CENTER-PAUMA UNIFIED (SAN LUIS OBISPO COUNTY) DISTRICT 400826 SONOMA VALLEY UNIFIED 401685 VALLEY HOME JOINT ELEMENTARY 400288 PLEASANTON UNIFIED 400622 SAN JUAN UNIFIED 401609 SONORA ELEMENTARY 401686 VALLEY ROP 401486 PLUMAS COUNTY OFFICE OF EDUCATION 400289 SAN LEANDRO UNIFIED 401610 SONORA UNION HIGH 401932 VAUGHN NEXT CENTURY LEARNING CENTER 401488 PLUMAS LAKE ELEMENTARY 400777 SAN LORENZO VALLEY UNIFIED 400924 SOQUEL UNION ELEMENTARY 401928 VENTURA CHARTER SCHOOL 401489 PLUMAS UNIFIED 401550 SAN LUCAS UNION ELEMENTARY 401611 SOULSBYVILLE ELEMENTARY 400870 VENTURA COMMUNITY COLLEGE DISTRICT 400458 POMONA UNIFIED 400710 SAN LUIS COASTAL UNIFIED 400673 SOUTH BAY UNION (SAN DIEGO COUNTY) 400871 VENTURA COUNTY OFFICE OF EDUCATION 401492 POND UNION ELEMENTARY 400712 SAN LUIS OBISPO COMMUNITY COLLEGE 401613 SOUTH BAY UNION ELEMENTARY (HUMBOLDT 400867 VENTURA UNIFIED 401493 POPE VALLEY UNION ELEMENTARY DISTRICT COUNTY) 400644 VICTOR ELEMENTARY 401497 PORTOLA VALLEY ELEMENTARY 401551 SAN LUIS OBISPO COUNTY OFFICE OF 401614 SOUTH FORK UNION 400653 COMMUNITY COLLEGE DISTRICT 400688 POWAY UNIFIED EDUCATION 401780 SOUTH MONTEREY COUNTY JOINT HIGH 400649 VICTOR VALLEY UNION HIGH 402007 PUBLIC SAFETY ACADEMY 400692 SAN MARCOS UNIFIED SCHOOL DISTRICT 400377 VINELAND ELEMENTARY 401025 PUC - CALIFORNIA ACADEMY FOR 400465 SAN MARINO UNIFIED 400576 SOUTH ORANGE COUNTY COMMUNITY COLLEGE 401939 VISIONS IN EDUCATION LIBERAL STUDIES 400733 SAN MATEO COMMUNITY COLLEGE DISTRICT DISTRICT 401688 VISTA DEL MAR UNION 401502 RAISIN CITY ELEMENTARY 400734 SAN MATEO COUNTY OFFICE OF EDUCATION 400900 SOUTH PASADENA UNIFIED 400682 VISTA UNIFIED 400680 RAMONA CITY UNIFIED 400729 SAN MATEO UNION HIGH 400731 SOUTH SAN FRANCISCO UNIFIED 400310 WALNUT CREEK ELEMENTARY 400930 RANCHO SANTE FE ELEMENTARY 400727 SAN MATEO-FOSTER CITY ELEMENTARY 400840 SOUTH SUTTER CHARTER 400478 WALNUT VALLEY UNIFIED 400573 RANCHO SANTIAGO COMMUNITY 401554 SAN MIGUEL JOINT UNION 400472 SOUTH WHITTIER ELEMENTARY 400693 WARNER UNIFIED COLLEGE DISTRICT 401555 SAN PASQUAL UNION ELEMENTARY 400473 SOUTHEAST ROP 401690 WASCO UNION ELEMENTARY 401503 RAVENDALE-TERMO ELEMENTARY 401556 SAN PASQUAL VALLEY UNIFIED 401615 ROC 401691 WASCO UNION HIGH 400723 RAVENSWOOD CITY ELEMENTARY 400491 SAN RAFAEL CITY ELEMENTARY 400352 SOUTHERN HUMBOLDT JOINT UNIFIED 401692 WASHINGTON COLONY ELEMENTARY 401506 RED BLUFF JOINT UNION HIGH 400494 SAN RAFAEL CITY HIGH 400380 SOUTHERN KERN UNIFIED 401693 WASHINGTON UNIFIED (FRESNO COUNTY) 400939 RED BLUFF UNION ELEMENTARY 400320 SAN RAMON VALLEY UNIFIED 401616 SOUTHERN TRINITY JOINT UNIFIED 400903 WASHINGTON UNIFIED (YOLO COUNTY) 400790 REDDING ELEMENTARY 400671 SAN YSIDRO ELEMENTARY 401617 SOUTHSIDE ELEMENTARY 400533 WASHINGTON UNION ELEMENTARY 400641 REDLANDS UNIFIED 400337 SANGER UNIFIED 400686 SOUTHWESTERN COMMUNITY COLLEGE DISTRICT 401695 WATERFORD UNIFIED 400459 REDONDO BEACH UNIFIED 400570 SANTA ANA UNIFIED 401618 SPENCER VALLEY ELEMENTARY 401696 WATTS LEARNING CENTER 400724 REDWOOD CITY ELEMENTARY 400743 SANTA BARBARA COMMUNITY COLLEGE 400532 SPRECKELS UNION ELEMENTARY 401697 WAUGH ELEMENTARY 401508 REDWOODS COMMUNITY COLLEGE DISTRICT DISTRICT 401879 SPRINGS CHARTER SCHOOL 400510 WEAVER UNION 401509 REED UNION ELEMENTARY 400744 SANTA BARBARA COUNTY OFFICE OF EDUCATION 401621 ST. HOPE PUBLIC SCHOOL #7 400847 WEAVERVILLE ELEMENTARY 400846 REEDS CREEK ELEMENTARY 401558 SANTA BARBARA COUNTY SPECIAL EDUCATION 400376 STANDARD ELEMENTARY 401699 WEED UNION ELEMENTARY 400654 RIALTO UNIFIED 400774 SANTA CLARA COUNTY OFFICE OF EDUCATION 400836 STANISLAUS COUNTY OFFICE OF EDUCATION 400319 WEST CONTRA COSTA UNIFIED 401512 RICHFIELD ELEMENTARY 401562 SANTA CLARA ELEMENTARY 401624 STANISLAUS UNION ELEMENTARY 400479 WEST COVINA UNIFIED 401514 RICHLAND-LERDO ELEMENTARY 400773 SANTA CLARA UNIFIED 401905 STEELE CANYON CHARTER HIGH SCHOOL 400332 WEST HILLS COMMUNITY COLLEGE DISTRICT 401515 RICHMOND ELEMENTARY 400466 SANTA CLARITA COMMUNITY COLLEGE DISTRICT 400707 STOCKTON UNIFIED 400383 WEST KERN COMMUNITY COLLEGE DISTRICT 401516 RIDGECREST CHARTER 400779 SANTA CRUZ CITY SCHOOLS 400540 STONE BRIDGE 401701 WEST PARK ELEMENTARY 400642 RIM OF THE WORLD UNIFIED 400778 SANTA CRUZ COUNTY OFFICE OF EDUCATION 400474 SULPHUR SPRINGS UNION ELEMENTARY 400818 WEST SIDE UNION ELEMENTARY 400816 RINCON VALLEY UNION ELEMENTARY 400741 SANTA MARIA JOINT UNION HIGH 401629 SUMMERVILLE ELEMENTARY 400766 WEST VALLEY-MISSION CC 401517 RIO BRAVO-GREELEY UNION ELEMENTARY 400740 SANTA MARIA-BONITA 401630 SUMMERVILLE UNION HIGH 401704 WESTERN PLACER UNIFIED 401518 RIO DELL ELEMENTARY 401565 SANTA MONICA BOULEVARD COMMUNITY 401631 SUMMIT PREPARATORY CHARTER HIGH 400556 WESTMINISTER ELEMENTARY 401519 RIO ELEMENTARY CHARTER 400756 SUNNYVALE 401705 WESTMORLAND UNION ELEMENTARY 400461 RIO HONDO COMMUNITY COLLEGE DISTRICT 400468 SANTA MONICA COMMUNITY COLLEGE DISTRICT 401636 SUNOL GLEN UNIFIED 401706 WESTSIDE ELEMENTARY 401520 RIPON UNIFIED 400467 SANTA MONICA-MALIBU UNIFIED 400809 SUNRIDGE CHARTER 400480 WESTSIDE UNION ELEMENTARY 401521 RIVER DELTA JOINT UNIFIED 400863 SANTA PAULA UNIFIED 400886 SURPRISE VALLEY JOINT UNIFIED 401707 WESTWOOD CHARTER 402013 RIVER OAKS ACADEMY CHARTER 400530 SANTA RITA UNION ELEMENTARY 401637 SUSANVILLE ELEMENTARY 401708 WESTWOOD UNIFIED 401522 RIVERBANK UNIFIED 401567 SANTA ROSA CHARTER 401638 SUTTER COUNTY OFFICE OF EDUCATION 401709 WHEATLAND ELEMENTARY 401525 RIVERDALE UNIFIED 401285 SANTA ROSA JUNIOR COLLEGE 401640 SUTTER UNION HIGH 401710 WHEATLAND UNION HIGH 400609 RIVERSIDE COUNTY OFFICE OF EDUCATION 400597 SANTA ROSE ACADEMY 401940 SWEETWATER SECONDARY SCHOOL 400894 WHITMORE UNION ELEMENTARY 403(b) ENROLLMENT FORM / PAGE 5 of 6 403(b) ENROLLMENT FORM

Plan # School District 400481 WHITTIER CITY ELEMENTARY 400482 WHITTIER UNION HIGH 400483 WILLIAM S. HART UNION HIGH 401712 WILLIAMS UNIFIED 401713 WILLITS CHARTER 401714 WILLOW CREEK ELEMENTARY 401715 WILLOW GROVE UNION ELEMENTARY 401716 WILMAR UNION ELEMENTARY 400883 WILSONA ELEMENTARY 400819 WINDSOR UNIFIED 401717 WINSHIP-ROBBINS 400941 WINTERS JOINT UNIFIED 401718 WINTON ELEMENTARY 400484 WISEBURN ELEMENTARY 400940 WOODLAND JOINT UNIFIED 401721 WOODSIDE ELEMENTARY 400820 WRIGHT ELEMENTARY 401723 YOLO COUNTY OFFICE OF EDUCATION 400838 YOSEMITE COMMUNITY COLLEGE DISTRICT 400489 YOSEMITE UNIFIED 400799 YREKA UNION ELEMENTARY 400937 YREKA UNION HIGH 400843 YUBA CITY CHARTER 400842 YUBA CITY UNIFIED 400874 YUBA COMMUNITY COLLEGE DISTRICT 400876 YUBA COUNTY OFFICE OF EDUCATION 400646 YUCAIPA-CALIMESA JOINT UNIFIED

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