Added Authorization: Early Childhood Special Education

Transcription

1 Application Packet for Added Authorization: Early Childhood Special Education Contact: Education Credential Programs Phone: (951) or (951) University of California, Riverside Extension Education Credentials Office 1200 University Avenue Riverside, CA 92507

2 Welcome! Thank you for your interest in UCR Extension s Added Authorization in Early Childhood Special Education program. In this document you will find the application form and a checklist to assist you in completing your application packet. The application fee of $50.00 can only be submitted by debit/credit card, please do not send cash or check. Please contact Student Services at (951) and refer to AEC- Added Authorization Early Childhood Special Education Application Fee to make this payment. In an effort to ensure your application is complete when received, we recommend when ordering your university transcripts to have them mailed to yourself, do not open them and submit them sealed with the application as one packet. We are committed to the highest possible level of customer service, and will review your application, once it is complete, within 10 business days 1. At that time a decision letter will be mailed to your home address. At any time during this process you are welcome to contact us with any questions or to check on the status of your application. We look forward to working with you! 1 Please note that submission of a completed application does not imply automatic acceptance into the program.

3 Applicants must possess: ADMISSION REQUIREMENTS 1. A bachelor s degree from an accredited institution with a cumulative minimum grade point average of 3.0 (based on a four-point scale). For applicants that hold a graduate degree, graduate GPA will also be considered. If the overall computed GPA is below the stated 3.0 minimum, an applicant may be asked to submit a letter of explanation. 2. Any one of the following Special Education Credentials issued in the State of California: Preliminary Clear Level I Level II APPLICATION CHECKLIST A complete application packet includes all of the following: 1. Completed application form 2. Non-Refundable Application fee - $50 (Please call Student Services (951) or and refer to AEC- Added Authorization Early Childhood Special Education Application Fee when paying.) 3. Official, Sealed Transcripts of all college coursework 4. Copy of all CA and out-of-state credentials 5. Three letters of reference, no older than 1 year Please return as one packet to: UCR Extension c/o Education Credentials Office 1200 University Ave. Riverside, CA

4 Credentials Office Use Only Date application fee paid Order number Verified by: Appropriate valid CA Credential Date verified Verified by: Approved Not approved: Needs further review Approved by Director of Ed. Not approved by Director of Ed. Date Received: APPLICATION FORM Added Authorization Early Childhood Special Education Program University of California, Riverside Extension * Required Information *Name: (First) (Middle) (Last) Previous or maiden name: *Date of Birth *Social Security Number: * address you check on a daily basis: Home address: Number and Street City Zip Code ( ) Area Code Phone Number Mailing address if different from home address: Please send all mailed correspondence to this address Number and Street City Zip Code

5 Employer Information: School/Site Name: Supervisor/Principal Name: School District & County Professional Experience: (Chronologically, current assignment first) District School Assignment Dates of Employment Supervisor District School Assignment Dates of Employment Supervisor District School Assignment Dates of Employment Supervisor Personal Information: Ethnicity- Please circle one (Responses are kept confidential and used for program quality purposes only): C= American Indian or Alaskan Native A= Black/African American E= Mexican/Mexican American/Chicano L= Latino/Other Spanish F= Caucasian/White/Non- B= Japanese/ Japanese American American Hispanic D= Chinese/ Chinese American M= Pacific Islander Y= Other Asian K= Filipino/Filipino American G= Decline to state X= Korean/ Korean American R= East Indian/ Pakistani D= Other

6 Academic Background: College Major/Minor Degree & Date College Major/Minor Degree & Date College Major/Minor Degree & Date References: Please list names of the instructors or education professionals from whom you will be requesting references. Name Title Name Title Name Title I verify that all of the information above is true and correct Signature of Applicant Date Thank you!