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Last updated: May 7, 2026
WebToCase-Waiver Request Page Form Type * SelectGeneral WaiverCDCR Waiver Institution/Program * Agency Name/Department/Unit/Program * Date Waiver Request Received Procurement Officer/Program Manager Name * Name * Email * Daytime Phone Number * Extension * SelectYesNo Ext. # * Street Address City State Zip Code Vendor Name * Vendor Address Purchase Order # Requested Delivery Date * Exemption Request Total Price (Pre-Tax) Exemption Item Total Price Quantity for Each Line Item Requested Description of items requested including all goods and/or services the contractor will provide: (Attach additional information if necessary i.e. catalog photocopy) * Justification for Exemption: Provide a detailed explanation. *Medical requests must include/attach the CALCTRA Medical Authorization Form. * Attachment1 Drop a file here or click to upload Choose File Maximum file size: 2.1MB Attachment2 Drop a file here or click to upload Choose File Maximum file size: 2.1MB Attachment3 Drop a file here or click to upload Choose File Maximum file size: 2.1MB Attachment4 Drop a file here or click to upload Choose File Maximum file size: 2.1MB Attachment5 Drop a file here or click to upload Choose File Maximum file size: 2.1MB Captcha Submit If you are human, leave this field blank.
Maximum file size: 2.1MB
