Child Development Associate Training Program Checklist Student Name: Campus Requested: Thank you for your interest in our Child Development Associate Training Program! The Continuing Education Specialist must obtain and review the following items before acceptance into the program: Pre-TASP Reading Test (minimum score of 14) * See testing waivers section of this application if you feel you may have a valid waiver Copy of high school transcript, college transcript or G.E.D. Copy of driver s license or other form of government I.D. Child Development Associate Training Application Field Advisor Consent Form Signed and completed Criminal Background Check Applicants will receive notification of acceptance and the registration form by mail. Take these two items along with the full payment to any campus Registration Office immediately. Classes are on a first come, first served basis. Please be aware that WCJC is only responsible for supplying you with 144 hours of instruction in child development to be applied towards your certification. It is the responsibility of the student to collect the additional 480 hours of professional experience as well as submitting a Direct Assessment Application for testing and certification to the Council of Professional Recognition. This should be done upon completion of the course and the field experience hours and requires a non-refundable fee of $325 paid separately to the council at the time the application is submitted. I have read and understand the conditions, terms, and requirements for acceptance in the Child Development Associate Training Program. Please be aware that WCJC does not provide health insurance for any student. Student Signature: Page 1 of 7
Applicant Name: Home Address: Child Development Associate Training Application Date of Birth: County: City: State: Zip: Phone: Home: Cell: Work: E-mail Address: Gender (please check): Male Female Ethnicity (optional, but appreciated for state reporting): EDUCATION Do you have a high school diploma or G.E.D.? If yes, please state year received: Have you attended college before? If yes, what program did you attend? If yes, what college did you attend? Did you receive a certificate or diploma for college? WORK EXPERIENCE What daycare center do you currently work at? What position do you hold? Will this be the licensed facility you will obtain your 480 hours of professional experience from? If no, please explain: PERSONAL INFORMATION Are you bilingual? Is English your primary language? If yes, what languages: If no, list other: Yes No Have you ever been convicted of a crime other than a minor traffic violation? Yes No If yes, explain: I certify that all information obtained herein is correct, and understand that the penalty for submitting fraudulent information for acceptance into the program is immediate dismissal from the program and withholding of grades and any tuition paid (once program has begun). Submission of application does not guarantee acceptance into the program. Signature: Page 2 of 7 To be completed by CE Specialist: Term: Course Numbers: Classroom Site: Received By:
Consent to Criminal Background Check (CBC) Child Development Associate Training Program Prior to registration for the Child Development Associate Training Program at Wharton County Junior College, students must have a criminal background check (CBC) performed as required by the Council of Professional Recognition in affiliation with Wharton County Junior College. All criminal background checks are considered confidential personal information and will be submitted only to authorized personnel with on a legitimate need-to-know basis. Refusal to consent to a criminal background check will result in a student being immediately dropped from the Child Development Associate Training Program. PLEASE PRINT: Student Name (Full Name): Maiden or other name(s) used for any other records: Address: County: City: State: Zip: Date of Birth: Gender (check one): Male Female Race: I, _, have read this document and understand its implications, and further agree that I will be required to undergo a criminal background check. I understand that any determination of ineligibility for participating in the Wharton County Junior College Child Development Associate Training will result in dismissal from the program. Student Signature: Printed Name: To be completed by CE Specialist: 01/24/2012 Term: CRN: KLB CBC Performed By: CBC Performance Clear for program: Yes No (Check One) If no, reason: Page 3 of 7
Field Advisor Consent Form Child Development Associate Training Program Please give the following 3 pages to the Field Advisor who will be monitoring your progress throughout the training program. This form must be completed by the Field Advisor before you can receive acceptance into the program. In order to be qualified as a Field Advisor for a Child Development Associate Training Program, you must meet the following criteria set by the Council of Professional Recognition: A. PERSONAL Affirm your ability to relate to people of various racial, ethnic, and socio-economic backgrounds. Be knowledgeable about local, state, and national requirements, standards, and guidelines for child care programs serving children. Be familiar with the center where the Candidate will be observed and the needs of families and children in the community. B. EDUCATION AND EXPERIENCE You must meet all of the requirements in one of the three combinations of education and experience outlined as options 1, 2, or 3 below: Option 1 I. B.A., B.S., or an advanced degree in early childhood education/child development or home economics/child development, from an accredited college or university. Must include 12 semester hours covering children aged birth through 5 years. II. Two years of experience in a child care setting serving children aged birth through 5 years, including: One (1) year working directly with children in the same age range as the children in Candidate's classroom, as a caregiver, teacher, child life worker, social worker, or similar role; and One (1) year of responsibility for the professional growth of another adult. Page 4 of 7
Option 2 I. Associate level (two-year) degree in early childhood education/child development or home economics/child development, from an accredited college or university. Must include 12 semester hours covering children aged birth through 5 years. II. Four years of experience in a child care setting in a program serving children aged birth through 5 years, including: Two (2) years working directly with children in the same age range as the children in Candidate's classroom, as a caregiver, teacher, child life worker, social worker, or similar role; and Two (2) years of responsibility for the professional growth of another adult. Option 3 I. An active CDA Credential plus 12 semester hours of study in early childhood education or child development at an accredited college or university covering children aged birth through 5 years. II. Six years of experience in a child care setting serving children aged birth through 5 years, including: Four (4) years working directly with children in the same age range as the children in Candidate's classroom, as a caregiver, teacher, child life worker, social worker, or similar role; and Two (2) years of responsibility for the professional growth of another adult. C. CONFLICT OF INTEREST To promote objectivity and credibility, the CDA Advisor: May not work as co-teacher with the Candidate on a daily basis in the same room or group. May not be the relative of a child in the Candidate's care at any time during the assessment process. May not be related by blood or marriage or other legal relationship to the Candidate. Page 5 of 7
Field Advisor Consent Form Child Development Associate Training Program PLEASE PRINT: Full Name: Phone Number: E-mail Address: Please check which Option under EDUCATION AND EXPERIENCE you meet to qualify for a Field Advisor: Option 1 Option 2 Option 3 I,, have read this document thoroughly and understand my duties as a qualified Field Advisor, and further agree to advise throughout the Child Development Associate Training Program. I certify this information is correct and that I do meet the necessary criteria as a Field Advisor. Signature: Printed Name: Page 6 of 7
Application Submission Methods The Child Development Associate Training Application may be submitted to the Continuing Education department by mail, fax, e-mail or in person by using one of the following contact methods: In Person or By Mail: Wharton County Junior College Fort Bend Technical Center Continuing Education Department (Suite 122) 5333 FM 1640 Richmond, TX 77469 By Fax: Please fax the completed application to 281-239-1628. By E-Mail: Please e-mail the completed application as an attachment to CE@wcjc.edu. Testing Requirement Waivers You may have the requirement for the Pre-TASP reading test waived if you have successfully completed any one of the following exams, or meets the requirements at another college or university as indicated on your transcript. Students must be able to provide proof of valid testing exemption. Copies of the test score or transcript are acceptable. ALL tests must have been taken within the past 3 years: TAKS Test Minimum score of 2200 and essay score of at least 3 THEA Minimum score of 230 on the reading portion of the exam COMPASS Minimum score of 81 on the reading portion of the exam ASSET Minimum score of 41 on the reading portion of the exam ACCUPLACER Minimum score of 78 SAT Minimum of 500 in Critical Reading (Verbal) = Writing/Reading exempt ACT Composite of 23 or higher with a minimum of 19 on English = Writing/Reading exempt Other Exemptions: Serving in the military (active duty), Texas National Guard, or as a member of the reserve unit and has been serving for at least three years preceding enrollment. A person who on or after August 1, 1990, was honorably discharged, retired, or released from active duty as a member of the armed forces of the United States or the Texas National Guard or service as a member of a reserve component of the armed forces of the United States. Page 7 of 7