CHILD DEVELOPMENT SPECIALIST AUTHORIZATION
Initial Application Checklist
Applicant’s Name: _____________________________________________________________________________ Application to become a Child Development Specialist (CDS) is accomplished through school district submission of required materials. Application materials should be submitted to the Oregon Department of Education prior to actual employment of the Child Development Specialist. Authorizations will not be processed without all materials being provided. The work of all CDS should align with the district’s Comprehensive Guidance and Counseling Programs. Go tohttp://www.ode.state.or.us/search/results/?=132 for more information. Application materials can be found at
http://www.ode.state.or.us/search/page/?id=393.
The following materials are required for authorization of new CDS:
_____ Updated Childhood Development Specialist Plan (This should be a part of the District’s Comprehensive Guidance Counseling Program. (One copy per district) Minor changes can be noted on the Request for Authorization Form.)
_____ Request for Authorization/Re-authorization Form
_____ A letter from the hiring superintendent or designated representative requesting authorization of the candidate
_____ Current resume of candidate documenting required education and other information pertinent to the position
_____ Transcript(s) documenting the coursework taken by the candidate (The OAR recommends a Master’s degree. We accept Master’s degrees in school counseling or a related field, such as psychology, social work, etc.)
_____ A copy of a completed fingerprint-based Criminal History Verification Form # 581-2283. (Copy of License requiring fingerprint based CHV can be used)
Three separate copies of the enclosed Competency Evaluation Form completed by: _____ The candidate
_____ A representative of the candidate’s former employment (or, lacking an appropriate employment history, a representative of the candidate’s graduate degree institution or recent academic preparation)
_____ The superintendent or designated supervisor of the candidate from the employing district
Once appropriate materials have been submitted, an authorization letter will be sent to the person requesting the authorization. If additional information is required, please contact Jennell Ives at (503) 947-5777, or by e-mail:
CHILD DEVELOPMENT SPECIALIST
Request for Authorization/Re-authorization
School Year 2013-2014
CDS Name(s) From PreviousContinueSchool Year
New For 2013-2014
School Year School
Deleted CDS Name(s) School
Update of Child Development Specialist Program Plan(Required for CDS authorization) Year your CDS program plan was last revised? ____ __
(CDS program plans should be a part of the District CGC Plan)
You are satisfied with your plan and are continuing implementation as outlined. (Y/N) ______ Web location of your CDS or Comprehensive Guidance Plan (provide link or submit a hard copy)
______________________________________________________________________ __
(Attach revised or updated plan, if necessary, using the CDS program plan template at the ODE website
http://www.ode.state.or.us/search/page/?id=393. There must be a plan on file to authorize CDS.)
District Name: _______________ __________________ County: _ _________ _________
Full District Address: _____ _________
___________ ________________ Phone: _____________ _________
Date: ________________________ Superintendent: __ _______ ___
CHILD DEVELOPMENT SPECIALIST
Application Competency Evaluation
(This form is to be completed by the applicant, district representative and previous employer, or professional reference.) Applicant’s Name: _____________________________________________________________________ School District: _____________________________________ Date: _____________________________
A CDS program, as an optional part of a district’s Comprehensive Guidance and Counseling (CGC) Program, facilitates student growth in four student developmental domains (pg. 7 and Appendix B). Please briefly describe the applicant’s experience in these four student development domains: 1. Academic
2. Career
3. Personal/Social
Please list/describe the activities the applicant is expected/able to perform as a CDS this 2012-2013 school year in the five CDS/CGC program content areas (pg. 22-26). Include strategies/activities with students, staff, administration, parents, and the community, to the extent appropriate. Also, please consider the applicant’s competencies and qualification in each of the following areas. Then rate him/her in each area, using the following five-point scale below:
1 2 3 4 5
Not Effective Below Average Average Above Average Outstanding
Guidance Curriculum–A Pre-K - 12 CGC program consists of developmental, preventative, and proactive instruction. (CDS Programs may be part of a district’s CGC program at the elementary level grades Pre-K - 8,pg. 10 and 26-28).
Rating: _____
Strategies/Activities:
Rationale:
Individual Planning– Activities that assist each student in setting and achieving academic, career, personal/social goals and in pursuing community involvement (pg. 11 and 28-30)
Rating: _____ Strategies/Activities: Rationale:
1 2 3 4 5
Not Effective Below Average Average Above Average Outstanding
Responsive Services–Intervention on behalf of individual students whose immediate needs, concerns, or problems are distracting or impeding their academic, career, or personal/social development or community involvement (pg. 11 and 30-32).
Rating: _____ Strategies/Activities: Rationale:
System Support and Integration–Ways in which guidance and counseling program staff contribute their knowledge and skills to promoting the infusion of the program throughout the school and overseeing program content (This might be professional development for other school staff and/or community,pg. 11 and 32-33).
Rating: _____ Strategies/Activities: Rationale:
1 2 3 4 5 Not Effective Below Average Average Above Average Outstanding Student Advocacy–Accommodations, modifications, special assistance, or any other support services required to ensure that each and every student receives equitable access and opportunities to
participate and succeed in school programs and successfully transition from school to adult life (While student advocacy/educational equity should be integral to all that CDS, counselors and other school staff do, there are still disparities between individual students and groups of students that require awareness and focused intervention,pg. 11 and 34-36).
Rating: _____ Strategies/Activities: Rationale:
Competency Evaluation: To be completed by applicant, district representative, and previous employer or professional reference.
CDS Applicant or Reference Signature: _____________________________________________________
Printed Name of CDS Applicant or Reference: _______________________________________________
Date: _______________________ Please mail to:
Jennell Ives, Education Specialist Oregon Department of Education
