Clear Credential Program

Transcription

1 Application Packet For Clear Credential Program 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 Clear Credential 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 be submitted by debit/credit card. Please contact Student Services at (951) or for instructions on how to make this payment. 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 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, which will be considered in making the admissions decision. 2. Any one of the following SB 2042 Credentials issued in the State of California: Preliminary Single Subject Credential Preliminary Multiple Subject Credential 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 Certificate Fee - CLR - Clear Credential when paying) Please do not send cash or check 3. Official, Sealed Transcripts of all college coursework. 4. Verification of passing the CBEST 5. Three letters of reference, no older than 1 year 6. Site Mentor Checklist signed by your principal 7. Copy of Site Mentor s clear CA credential 8. CL-855 signed by your superintendent or his or her designee

4 APPLICATION FORM Clear Credential Program University of California, Riverside Extension Credentials Office Use Only Date Received: Application Fee (REQUIRED) DATE PAID VERIFIED BY: Verification of valid CA Credential DATE VERIFIED VERIFIED BY: * Required Information *Name: (Last) (Middle) (First) Previous or maiden name: *Date of Birth *Social Security Number: * Work Personal Home Address: Number and Street City Zip Code ( ) Area Code Phone Number

5 Please indicate how you would prefer to receive communication from UCR Extension: to the work address indicated above to the personal address indicated above Mail to my home address 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

6 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 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 Please return to: UCR Extension Education Credentials Office 1200 University Ave. Riverside, CA Thank you!

7 Site Support Teacher Checklist CLEAR Credential Candidate s Name: Site Support Teacher s Name: Employer: Phone #: Qualifications/Requirements Possess a valid clear CA credential and academic background and experience in specific content area to be able to evaluate a teacher s competence. Possess a master s degree or higher Be able to facilitate the transition from teacher preparation to a Clear Credential by providing opportunities for demonstration and application of the pedagogical knowledge and skills required of teachers during their preliminary credential program. Be accessible for conducting observations and mentoring on an ongoing basis Additional skill or qualifications: Met expectations Does not meet expectations Reviewed By School/District Representative: Approved Date Signature Title Reviewed by: Associate Dean/Director of Education Extension/Credentials Office Signature Date