Education Specialist
Mild/Moderate
Education Specialist
Mild/Moderate Fast Track Option
Multiple Subject
Single Subject
English, Math, Science, Social Science and Spanish
Single Subject
English, Math, Science Early Completion Option
Intern Preliminary Credential Program
EnCorps Application
2012 – 2013
Dear Intern Applicant:
Thank you for your interest in the UCLA Extension Intern Preliminary Credential Program.
Our Intern Program enables candidates to complete their teacher preparation coursework while working full-time as an intern teacher. Classes are offered primarily online, and in a blended format (a combination of both classroom-based/online instruction) beginning with an intensive pre-service component in Summer quarter for candidates who are new to teaching.
This program is designed for individuals who have, or will have, a full-time teaching position in a school, or school district. Individuals who do not yet have a job offer may still be accepted into the intern program and participate in the coursework. However, employment must be secured with a verification letter from a school or school district indicating either a start date or intent to hire date as an intern classroom teacher before an Intern Credential can be issued. Candidates are
responsible for finding their own employment. While we do not guarantee placement, we will provide job search assistance.
The Intern Credential Program provides an alternative route of teacher credentialing. Benefits that are unique to the UCLA Extension Intern Program include:
Affordable tuition [special discount for EnCorps participants]
Online and blended classroom formats
Highly qualified and experienced instructors
Rigorous, research-based curriculum focused on classroom application
Continuous intern support via individual support providers, online resources, and seminars
A wide variety of teacher placement locations (charters, public and non-public schools)
Social justice emphasis
The outstanding, Internationally-recognized reputation of UCLA and UCLA Extension Attached is the intern application packet. It must be completed and submitted along with the additional materials as outlined in the Program Requirements section. All completed applications will be reviewed by the Intern Program Admissions Committee. Upon acceptance, intern
candidates will receive detailed information regarding summer pre-service and the intern program orientation.
If you have any questions regarding the program or the application process, please contact Miriam Sims at (310) 825-0095 or [email protected].
We look forward to the opportunity of serving you in your professional development.
Cordially,
Kate Edwards, PhD, Program Director
INTERN PROGRAM REQUIREMENTS – ENCORPS
To be eligible for admission to Intern Preliminary Credential Program, candidates must meet the following requirements:
1. Bachelor’s Degree from a regionally accredited college or university, or foreign
equivalency. (Applicants who are currently completing an undergraduate program may obtain eligibility by means of an official transcript as proof of Bachelors Degree program in progress at an accredited university. However, candidate may not enter classroom as a teacher of record until the degree has been conferred.)
2. Successful completion of the U.S. Constitution requirement via exam or coursework 3. Verification of passage of the CBEST
4. Evidence of subject matter competency via successful completion of the CSET exam 5. Grade point average of 3.0 or higher
6. Access to a computer, a valid email address, and working knowledge of basic computer applications including word processing applications, internet browsers, and email
7. Completion and submission of the UCLA Extension Intern Program application packet 8. Verification letter from a school or school district indicating either a start date or intent to
hire date for employment as a Teacher or Resource Specialist
(Candidates who do not have an offer of employment at the time of application submission may still apply and submit the letter of verification separately to UCLA Extension once employment is offered.)
Special Note:
For candidates interested in the Early Completion Option (available for Single Subject English, Math, or Science only), there are additional requirements. For requirements on this option, please download CTC Leaflet CL-840 at http://www.ctc.ca.gov/credentials/leaflets- number.html.
Education Specialist candidates who already hold a Multiple or Single Subject Teaching Credential should choose the SPED Fast Track Option.
IMPORTANT DATES
Application
Deadlines:
Financial Aid Deadline:
Last day to turn in a completed federal financial aid packet to
the Financial Aid Office. Quarter Schedules:
Summer 2012 May 1, 2012 May 15, 2012 June 25 – September 16 Fall 2012 July 13, 2012 August 1, 2012 September 24 – December 16 Winter 2013 October 19, 2012 November 1, 2012 January 7 – March 31, 2013 Spring 2013 January 18, 2013 February 5, 2013 April 1 – June 23, 2013
Candidates who are new to teaching must start in Summer; Fast-Track teachers may start in any quarter.
PROGRAM COSTS – ENCORPS Certificate Fee:
A non-refundable certificate fee of $100 is WAIVED for EnCorps Participants.
Program Tuition Fee and Payment Plan:
All textbooks and course materials are included in the tuition fee. Tuition is paid in quarterly installments commencing with the first quarter in which you are enrolled. Upon acceptance into the program, you will receive detailed information regarding your payment schedule. Tuition fees are as follows:
Tuition for EnCorps 1-Year Participants: $12,000 (regularly $14,000)
Quarterly tuition breakdown fee: $4,000 paid in Fall, Winter, and Spring quarters
Tuition for EnCorps 2-Year Participants: $13,500
Quarterly tuition breakdown fee: $2,800 paid in Fall, Winter, and Spring quarters of year 1; $1,275 paid in Fall, Winter, Spring, and Summer quarters of year 2
FINANCIAL AID Federal Direct Loans
The intern programs qualify for federal financial aid in the form of Direct Loans (subsidized and unsubsidized). Upon acceptance into the program, please contact our Financial Aid Office at (310) 825-4246 or [email protected]. Please remember to identify yourself as a “UCLA Extension Intern Program Student.”
Students who intend on paying program costs through federal financial aid must submit a completed financial aid application packet by the published deadlines to allow adequate time for processing (requires six weeks). Students who do not meet the deadline dates will be
responsible for paying all course fees in advance, until their financial aid application is processed.
If you are a Federal Financial Aid recipient, you must be officially enrolled in all courses you are taking in a given quarter by the end of the second week of the quarter. Academic year 2012-13 enrollment deadlines are: Summer 2012: July 6, 2012; Fall 2012: October 5, 2012; Winter 2013:
January 18, 2013; and Spring Quarter 2013: April 12, 2013. If you do not enroll by this deadline, your financial aid award will be cancelled. If your award is cancelled, you will need to reapply for financial aid (a 4-week process) and either pay the current quarterly fee or wait until the next quarter to enroll in courses and continue your program. In addition, you may be assessed late fees and a “hold” may be placed on your UCLA Extension academic record.
Financial Aid Deadlines (see Important Dates above):
Contact the Financial Aid Office at (310) 825-4246 or [email protected] for information regarding the deadlines printed above and procedures related to filing for federal financial aid.
CBEST and CSET EXAMINATION INFORMATION
All intern applicants are required to show verification of passing the CBEST prior to application submission and evidence of subject matter competency via: successful completion of the CSET exam, or completion of a Commission-approved subject matter program of coursework (applicable to Single Subject only).
CBEST California Basic Educational Skills Test
The CBEST was developed to meet requirements of laws relating to credentialing and employment. This test requirement in no way replaces any of the other requirements of subject matter knowledge, professional preparation, and practice teaching or field experience used in the issuance of credentials. The CBEST is designed to test basic reading, mathematics, and writing skills found to be important for the job of an educator; the test is not designed to measure the ability to teach those skills.
All intern applicants are required to pass the CBEST prior to application submission. Testing preparation information is available through the CBEST website. For further information regarding the exam,
preparation materials, registration deadlines, and registering for the test online, please visit the website at www.cbest.nesinc.com.
CSET California Subject Examinations for Teachers
The CSET was developed by the California Commission on Teacher Credentialing to meet the subject matter competence requirement for specific credentials and is required to teaching in classrooms. Each test consists of subtests that cover specific domains of subject matter, and each includes multiple-choice and/or constructed-response test items. Examinees will be provided five uninterrupted hours of testing time in which to complete, in the order of their choice, and or all subtests for which they have registered;
subtests will not be separately timed.
Which test should you take?
Multiple Subject & Education Specialist M/M Candidates should take the Multiple Subject exam Single Subject Candidates should take the exam in your specific subject area (English, Math, Science, Social Science, Physical Education, or Mandarin).
Testing preparation information is available through the CSET website. For further information regarding the exam (including the various exams available for Multiple Subject and Single Subject), preparation
materials, registration deadlines, and information regarding registering for the test online, please visit the website at www.cset.nesinc.com.
While intern candidates are permitted to submit their applications without CSET scores, passage of the CSET is required prior to formal admission into the program and University Intern credential recommendation.
EMPLOYMENT
This program is designed for individuals who have, or will have, a full-time teaching position in a school, or school district. Individuals who do not yet have a job offer may still be accepted into the intern program and participate in the coursework. However, employment must be secured with a verification letter from a school or school district indicating either a start date or intent to hire date as an intern classroom teacher before an Intern Credential can be issued. Candidates are responsible for finding their own employment.
While we do not guarantee placement, UCLA Extension provides job search assistance.
Intern employment conditions are as follows:
1. Employment must be secured from a K-12 public school (including charter and non-public schools). Private schools including parochial schools are not eligible as employers for the intern program. Preschool or Early Childhood Education positions are not eligible unless they require a Multiple Subject or Education Specialist Mild/Moderate credential
2. Employment must be secured as Teacher of Record including Classroom Teacher or Resource Specialist in the credential subject area. Resource Specialists may be full-time or part-time.
Substitute teacher or teacher aide is not an eligible employment position for the intern credential 3. Employment must be in the appropriate credential subject area. For example, a Single Subject
English Intern must teach in a Single Subject English setting. An Education Specialist must teach in a setting that requires the special education credential
The UCLA Extension staff maintains good communication and connections with local district and charter school teacher recruiters. When information regarding job postings is given to UCLA Extension, it is distributed to all interns in the program who are seeking employment. However, intern candidates should regularly check with the following job position resources:
1. EDJOIN.Org – www.edjoin.org
Text from their website: With over 1,800 school districts, county offices of education and other education agencies posting on the network regularly, you'll find up to 16,000 job vacancies in EDJOIN's database!
2. California Charter School Association (CCSA) – www.calcharters.org
Provides contact information for all charter schools in California. Candidate may visit websites or contact HR directors at individual schools for job information.
3. California Department of Education (CDE) - http://www.cde.ca.gov/re/sd/
Provides contact information for all schools in California. Candidate may visit websites or contact HR directors at individual schools for job information.
4. California Association of Private Special Education Schools (CAPSES) – www.capses.com Provides contact information for all non-public (special education) schools in California.
Candidate may visit websites or contact HR directors at individual schools for job information.
INTERN CREDENTIAL COURSES
Detailed course schedule information will be given upon acceptance into the program. Grid below is subject to change
Course # Course Title Units SPED
NEW
SPED
FT** MS/SS Summer One
Orientation – full day with instruction X X X
X 424.1 Educational Foundations 3 X X
X 428.13A Teaching Foundations A 6 X X
X 428.13B Teaching Foundations B 6 X X
Fall
X 328.8 Special Needs Learners 3 X X
X 428.4 Dev Safe Learning & Positive Behavior 3 X X X X 424.20A /
X 424.21A
Methodology (for employed teachers) 3
X X
X 428.12B Seminar (for employed teachers) 2 X X X
X 428.11A Internship Practicum (for employed teachers)* 6 X X X Winter
X 315 Principles and Methods of Teaching Reading 4.5 X X
X 424.667 Response to Intervention (RTI) 1.5 X X X
X 428.5/5G Assessment of Students 3 X X X
X 424.20B / X 424.21B
Methodology (for employed teachers) 3
X
X 428.12C Seminar (for employed teachers) 2 X X X
X 428.11B Internship Practicum (for employed teachers)* 6 X X X Spring
X 312.8A Health Education for Teachers 1.5 X X
X 428.6 / X 333.8 Technology 3 X X X
X 428.9 Effective Communication & Collaborative Partnerships
3 X X X
X 429.20A Characteristics of Students w/ASD 4.5 X X
X 424.20C / X 424.21C
Methodology (for employed teachers) 3
X
X 428.12D Seminar (for employed teachers) 2 X X X
X 428.11C Internship Practicum (for employed teachers)* 6 X X X Summer Two
X 426.1 Language & Language Development 4 X X
X 426.3 Foundations & Methods of ELL 6 X X
X 426 Culture & Inclusion 4 X X
TOTAL UNITS 83 45 84.5
INTERN PROGRAM COURSE DESCRIPTIONS
For individualized course requirements, please see individual course grid provided to you upon acceptance.
■ EDUC X 312.8A
Health Education for Teachers (1.5 units)
An introductory exploration of health and introduction to creating a supportive healthy environment for student learning through knowledge and awareness. An emphasis is placed upon exploration through effective classroom management. This course provides an integrated curricula approach to health by infusing the components of nutrition, sexually transmitted diseases, and substance abuse (including alcohol, drugs, tobacco, and narcotics) into the general curriculum. The emphasis of this course is to promote an overall healthy lifestyle that encourages lifelong practices. This course satisfies the CTC requirements for a clear credential.
■ EDUC X 315
Principles and Methods for Teaching Reading (4.5 units)
Instruction covers the interaction and significance of reading, writing, listening, and speaking in relation to literacy development. Instruction presents a balanced, comprehensive, and
integrated reading/language arts program based on literature, skill development, reading, writing, listening, and speaking activities as well as reading/language arts strategies that are sensitive and responsive to individual needs of all students and suitable for incorporation in all subject area instruction
■ EDUC X 328.8
Special Needs Learners (3 units)
In this course, students will be introduced to learning theories, strategies, classroom
management and issues related to the characteristics, needs, and models of instruction needed to promote optimal learning for students with identified special needs. The students will be able to create an individualized instructional program for his/her classroom through skills assessment, strategies for adapting material and goals, and addressing potential risk factors.
■ EDUC X 333.8
Educational Technology in the Classroom (3 units)
Instruction offers a basic introduction to integrating microcomputer technology into the existing curricula of K-12 classrooms, including recognition of English language development of students.
Topics include basic computer operation and troubleshooting, extended word processing, drawing/painting, spreadsheet/database, multimedia presentation, website production, and effective software selection.
■ EDUC X 424.1
Education Foundations (3 units)
This course presents educational foundations relevant to the development and maintenance of an effective and successful learning environment. Topics include theories, policies, and
principles that influence the educational process; human learning and development,
research/theory impacting classroom instruction; and techniques and strategies for effective instruction and classroom management with attention to space, time, materials, student behavior, record keeping, and assessment.
■ EDUC X 426
Culture and Inclusion (4 units)
This course examines culture and cultural diversity and the relationship to academic
achievement, development, implementation, and evaluation of culturally inclusive instruction.
Topics include cultural concepts and perspectives, cultural contact, cultural diversity in
California and the United States, cross-cultural interaction, the roles of culture in the classroom and the school, culturally inclusive learning environments, family and community involvement, and culturally inclusive curriculum and instruction.
■ EDUC X 426.1
Language and Language Development (4 units)
This course focuses on research-based conceptual understanding of language systems,
structures, forms, functions, and variations of both aural and written language forms. Instruction covers applying language functions and variations, discourse, and pragmatics directly to
assessment and instruction of English learners; specific linguistic and socio-linguistic challenges of English learners; and materials and methods for understanding and analyzing socio-cultural and political factors that can affect second-language development.
■ EDUC X 426.3
Foundations and Methods of English Language/Literacy Development and Content Instruction (6 units)
Current research-based theories of second language acquisition and the differences between first and second language and literacy development are explored in this course. Topics include cognitive, linguistic, and socio-cultural factors that affect language learning in children of diverse backgrounds; use of the California English Language Development standards and the English Language Development Test (CELDT) in instructional planning that promotes language development and academic achievement; and research-based approaches and methods for English-language development in listening, speaking, reading, and writing as they relate to communicative competence. Presentation of knowledge and skills to deliver comprehensible instruction to English learners in the context of three instructional models--English Language Development (ELD), Content-based ELD, and Specially Designed Academic Instruction in English (SDAIE)--are presented.
■ EDUC X 424.667
Response to Intervention (1.5 units)
Response to Intervention' (RTI) is an emerging approach to effectively diagnose and meet the need of general education students who are having difficulties in learning. In the RTI model, a student with academic delays is given one or more research-validated interventions. The
student's academic progress is monitored frequently to see if those interventions are sufficient to help the student to catch up with his or her peers. This course explores a variety of RTI models and strategies currently employed in California school districts.
■ EDUC X 429.20A
Characteristics of Students with Autism Spectrum Disorder (ASD) (4.5 units)
■ EDUC X 428.11
Internship Practicum (6 units) – to be taken in the Fall, Winter and Spring quarters
The Intern Practicum is considered a fieldwork class, which means that you must be the teacher of record in a classroom. Based on the CA Teacher Performance Assessments, your assigned Support Provider makes observations of your classroom teaching and provides feedback, guidance and support.
■ EDUC X 424.20/.21
Methodology (3 units) – to be taken in the Fall, Winter and Spring quarters
Designed to introduce content and methods for teaching K-12 students. Topics include theory, assessment, and an overview of content included in the multiple or single subject curriculum. The primary focus is the development of your personal teaching philosophy as well as new creative classroom methodologies that will enable you become an excellent, effective teacher. This course includes ongoing preparation for the Performance Assessment for California Teachers (PACT) event in Spring Quarter.
■ EDUC X 428.12
Seminar (2 units) – to be taken in the Summer, Fall, Winter and Spring quarters
The experiences you bring to seminar are the content we study. Each quarter will focus on topics that are pertinent to your current experiences in the classroom. A number of online resources related to individual topics are provided for you. Self-reflections and group discussions are completed weekly.
■ EDUC X 428.13A
Teaching Foundations A
Foundational knowledge of the skills and abilities addressed in the Commission’s Teaching Performance Expectations or equivalent in special education. This preparation includes instruction about: classroom management and planning; developmentally appropriate teaching practices; general and subject or specialty specific pedagogy; teaching English learners; and communication skills including reading. Must be taken concurrently with X 428.13B.
■ EDUC X 428.13B
Teaching Foundations B
Foundational knowledge of the skills and abilities addressed in the Commission’s Teaching Performance Expectations or equivalent in special education. This preparation includes instruction about: classroom management and planning; developmentally appropriate teaching practices; general and subject or specialty specific pedagogy; teaching English learners; and communication skills including reading. Includes classroom observations and teacher interviews, as well as job interviewing and job hunting skills . Must be taken concurrently with X 428.13B.
■ EDUC X 428.4
Developing Safe Learning Environments and Positive Behavior Supports (3 units)
In this course students will examine how to manage safe and effective learning environments for diverse learners. Participants will learn how to foster self-esteem, self-advocacy, appropriate behavior and social skills in their own students. Principles and applications of behavioral support and intervention for successful classroom learning and positive social interaction among
students in the classroom.
■ EDUC X 428.5
Academic Assessment of Students with Special Emphasis on Special Needs Students (3 units) This course focuses on informal and formal diagnostic procedures appropriate for general education students as well as students with mild to moderate disabilities. Topics also include legal requirements for eligibility, formulating individualized education plans (IEPs) based on assessment data and general evaluation of instruction. In addition, students explore assessment tools and practices as they relate to English learners and assessment as a basis for instruction.
Teachers learn to administer multiple assessments to diagnose and document a student's educational development.
■ EDUC X 428.5G
Assessment of Students (3 units)
This course focuses on informal and formal diagnostic procedures appropriate for general education students as well as students with mild to moderate disabilities. Topics also include legal requirements for eligibility, formulating individualized education plans (IEPs) based on assessment data and general evaluation of instruction. In addition, students explore assessment tools and practices as they relate to English learners and assessment as a basis for instruction.
Teachers learn to administer multiple assessments to diagnose and document a student’s educational development.
■ EDUC X 428.6
Technology with Diverse Learners (3 units)
This interactive course focuses on the use of the computer in the classroom environment.
Participants learn to use a variety of applications common to the computer-oriented classroom and receive an orientation into lesson planning and assigning projects using computer hardware and software. Computer networking also is discussed. Participants learn how computers are connected to each other and to peripherals and are introduced to the design of internet networking as well as assistive technology.
■ EDUC X 428.9
Effective Communication and Collaborative Partnerships (3 units)
This course focuses on effective collaboration and communication skills for engaging learners with disabilities, significant family members, and other professionals; participating as a team member in preparing programs for individual learners; developing, implementing, and evaluating integrated services in reflection of transitional stages across the life span.
INTERN PROGRAM APPLICATION CHECKLIST
Candidate’s Name (Mr./Ms.): ___________________________________________________________________________
Multiple Subject
Single Subject – Specify: English Math Science Social Science Spanish
Education Specialist
Education Specialist (Fast-Track Option] – for candidates who hold a previous CA teaching credential The following items must be completed and submitted with the Intern Program Application by the application deadlines on page 4.
1. UCLA Extension Application and Checklist
2. Non-refundable $100 certificate fee payable online at www.uclaextension.edu.
Choose one of the three CF codes below, enter in the Quick Enroll tab, and follow prompts to proceed. Payments may also be made via phone by calling 310-825-9971.
CF575: Education Specialist Credential, CF576: Multiple Subject Credential, or CF577: Single Subject Credential
3. Official Transcript(s) from accredited college and/or university attended, verifying award date of baccalaureate degree or higher. If applicable, include transcripts for all teacher preparation coursework completed at other institutions. If transcript is from an institution outside of the United States, a Foreign Transcript Evaluation must also be submitted
4. Copy of CBEST Score Report verifying passage of the exam
See Commission on Teacher Credentialing website for details regarding additional options for meeting the basic skills requirement. These options are described in leaflet CL-667 available at:
http://www.ctc.ca.gov/credentials/leaflets/cl667.pdf
5. Copy of CSET Score Report [Please note that the CSET is not considered Passed until all subtests for the examination have been passed.]
6. Copy of current or most recent California credential or permit, or copy of Certificate of Clearance (Livescan)
7. Three Letters of Recommendation Letters should be signed, on school letterhead, and no more than two years old
8. Statement of Intent Please include a brief statement addressing your reasons for applying to the program. Your statement should include: your short-term and long-term career goals; reasons for selecting the program; and why you believe you will become an outstanding K-12 educator
9. Resume Your resume should describe prior work experience including positions held outside of an educational setting. Please also include any volunteer experience as well as any specific skills, talents, and interests
10. Verification letter from a school or school district indicating either a start date or intent to hire date for employment as an intern teacher. Please note: Candidates who do not have an offer of employment at the time of application submission may still be accepted into the intern program and participate in coursework but must submit employment verification before an Intern
Credential can be issued.
Please write CF code on check or money order and mail payment with application to:
Department K, UCLA Extension, P.O. Box 24901, Los Angeles, CA 90024 (Do not send checks to Education Department)
If paying by phone or online, mail application to:
UCLA Extension Education Department,
10995 Le Conte Avenue, Suite 639, Los Angeles, CA 90024, Attn. Miriam Sims
INTERN PROGRAM APPLICATION FORM
I am applying for admission to: Summer 2012 Fall 2012 Winter 2013 Spring 2013
Subject: Multiple Subject
Single Subject–Specify Subject: English Math Science Social Science Spanish
Education Specialist
Education Specialist (Fast-Track option) for candidates who hold a previous CA credential
Do you hold a previous teaching credential? No Yes
If yes, please indicate type of credential: _____________________________________________________
Are you transferring from another Intern Program? No Yes _________________________________
(indicate name of other Intern Program)
With regard to your professional experience in education, check as many that apply:
Paraprofessional Teaching Assistant Other: ______________________________________________
How did you hear about our program? Facebook Other: ___________________________________
(please specify)
Personal Information
Name (Mr./Ms.) _____________________________________________________ __________________________
(circle one) (Last) (First) (Middle) (Maiden/Former)
Home Address ___________________________________________ ___________________________________
(Street Address, Apt #, if applicable) (City, State & ZIP Code)
E-mail address ________________________________________________________________________________________
Home Phone ______________________________________ Work or Cell Phone ________________________________
Social Security Number: ________ - ________ - ________ Date of Birth: __________ /__________ / __________
(month) (day) (year)
Have you secured employment as a Teacher or Resource Specialist in the credential area that you are applying for? No Yes If yes, complete the following:
Name of Employing School (if applicable) : ________________________________________________________________
School Address: _______________________________________________________________________________________
School District : ________________________________________________________________________________________
Current Position : ____________________________________________ Grade Level : _________________________
Principal Name: ______________________________________ Principal Phone : ____________________________
Subject Matter Competency verified by: (check one) Multiple Subject
CSET (California Subject Examination for Teachers) Date Passed: _____________________
Other: ____________________________________________ Date Passed: _____________________
(Specify exam title)
Single Subject (indicate subject) ___________________________________________________
CSET (California Subject Examination for Teachers) Date Passed: _____________________
Completion of Commission-approved subject-matter program or verification of subject matter waiver Date Completed: ______________________ (Attach a copy of college or university letter.)
International Applicants Only
TOEFL (Test of English as a Foreign Language)
Date Taken: ___________________________ (Attach a copy of your score report.) Country of Citizenship: ______________________________________________________________
Foreign Transcript Evaluation (Attach foreign transcript evaluation.)
Academic Background
Please submit official transcript(s) verifying baccalaureate degree or higher and include transcripts from all colleges/universities attended, including teacher preparation coursework.
Name & Location of College or
University Attended Dates
Attended GPA Type of Degree or
Credential Date Conferred or
Expected for Degree or Credential
Current Teaching Credentials
Please enclose a copy of your current or most recent permit or credential, or Certificate of Clearance (Livescan).
Type of Credential / Permit State Where
Issued Date Issued Date Expires Authorization
Teaching Experience (or Related Experience with Children) Please list your most recent experience first.
School or Agency Date of
Service Supervisor/
Administrator Contact Phone Subject
Other Professional Experience Please list most recent experience first.
Dates of Service Position Held Employer
Letters of Recommendation/ Professional References
Three letters of recommendation are necessary. Letters of recommendation must address each of the following four categories: (1) your academic competence; (2) your expertise with children and youth from diverse backgrounds—ethnic, cultural, socioeconomic; (3) your experience in educational setting; and, (4) your knowledge and/or experience with individuals with special needs. Note: Letters should be sealed and submitted by applicant along with other application materials.
Name of Professional Reference Title Organization
