Application Packet For Designated Subjects Credential Adult Education Career Technical Education Special Subjects Contact: Education Credential Programs Email: credentials@ucx.ucr.edu Phone: (951) 827-1661 or (951) 827-1654 University of California, Riverside Extension Education Credentials Office 1200 University Avenue Riverside, CA 92507
Welcome! Thank you for your interest in UCR Extension s Career Technical Education and Special Subjects 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) 827-4105 and refer to Certificate Fee-CTE- Career Technical Education and Special Subjects 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. Once you have received your acceptance letter, please contact us to mail you the Preliminary Credential paperwork. We look forward to working with you! 1 Please note that submission of a completed application does not imply automatic acceptance into the program.
Applicants must possess: ADMISSION REQUIREMENTS 1. A High School Diploma or GED 2. Job offer or current teaching position requiring the credential 3. Three (3) years of work experience directly related to each industry sector to be named on the credential (CTE only). 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) 827-4105 refer to Certificate Fee-CTE-Career Technical Education and Special Subjects when paying) 3. Copy of High School Diploma/GED or Official, Sealed college/university transcript (required when verifying US Constitution or Health course) 4. Verification of Current Teaching Position or Offer of Employment form (DS 5-13) 5. Intent to Complete All Requirements to Clear My Preliminary Designated Subjects Credential form (DS 6-13) Not required for clear MS/SS Credential Holders Additional Requirements for Bridge Clear MS/SS Credentials holders: 6. Copy of valid CA clear MS or SS credential 7. Verification of appropriate EL Authorization 8. Intent to Complete and Clear All Credential Requirements for Bridge Clear MS/SS credential holders (DS 10-14) Please return as one packet to: UCR Extension c/o Education Credentials Office 1200 University Ave. Riverside, CA 92507-4596 Once you have been accepted to the program please contact the Credentials Office at credentials@ucx.ucr.edu for instructions regarding applying for your preliminary credential.
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 Designated Subjects Credential Program University of California, Riverside Extension * Required Information *Name: (First) (Middle) (Last) Previous or maiden name: *Date of Birth *Social Security Number: _ *Email 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
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
Academic Background: High School Major/Minor Degree & Date College Major/Minor Degree & Date College Major/Minor Degree & Date Designated Subject Program: Please check which program you wish to enter: References: Adult Education Career Technical Education (CTE) Career Technical Education (CTE) Bridge for Clear MS/SS Credential holders Special Subjects Please list name of the past employer(s) from whom you will be requesting verification of experience. (CTE only) Name Title Name Title Name Title I verify that all of the information above is true and correct Signature of Applicant Date Thank you!
Verification of Teaching Position and New Teacher Support (Please print) This form must be completed by an employing agency when a Designated Subjects Adult Education, CTE or Special Subjects Preliminary credential is being requested. After this from is completed the teacher must provide it to UCR Extension in order to apply to the Designate Subjects Adult Education, CTE, or Special Subjects credential programs. Employing Agency: (Name of school district) Name of Applicant: Type of credential requested: CTE Special Subjects Adult Education As the authorized representative of the employing agency listed above: (Initial) I certify that the above individual is currently employed or has an offer of employment to teach for the district. (Initial) I certify that supervisors and support providers of the beginning teacher are experienced in teaching, trained in supervision and support, and evaluated on their service to beginning teachers. Signature: Name and Title: Contact Phone Number: Email: Note: For a district or county office of education, this form must be signed by the district or county superintendent or his or her designee. For programs sponsored by a private K-12 school, non-public, non-sectarian school or agency, charter school, or a school operated under the direction of a California state agency, the individual legally authorized to sign documents on behalf of the organization or a designee will be responsible for signing this form. DS 5-13
University of California, Riverside Extension Designated Subjects Credential Program Intent to Complete and Clear All Credential Requirements I agree that I will inform UCR Extension if I change my email address. I agree that I will have daily access to a computer and email. I agree that I have computer literacy skills including the ability to utilize the internet as well as download, print and create PDF documents. (If not, it is recommended that you do not enroll in the program or submit the credential application at this time.) I hereby promise to enroll and complete the Early Orientation within thirty (30) days of obtaining my teaching position. I understand it is my responsibility to enroll in all the required classes. I understand classes can be found in the quarterly catalog or at www.extension.ucr.edu I certify that I understand the requirements that I must complete in order to clear the Preliminary Designated Subjects credential within the 3 year (5 year for special subjects) preliminary period as outlined below. I understand that the course work must started during the first available quarter after receiving my Preliminary Designated Subjects Credential recommendation. Credential Program Coursework Requirements: EDUC 814.7 Orientation: Career Technical Education (non-credit) EDUC X309.01 CTE Early Orientation (2 units) EDUC X309.02 Classroom/Laboratory Management & Safety (2 units) EDUC X309.03 CTE Curriculum & Instruction (4 units) EDUC X309.04 Assessing Student Learning (3 units) EDUC X309.05 Teaching English Learners & Students with Special Needs (3 units) EDUC X309.06 CTE Foundations and Professional Legal/Ethical Responsibility (1.5 units) EDUC X309.07 Culmination Portfolio (1.5 units) Health Education Requirement: EDUC X451.01 Implementation of Health Instruction Framework for CA Schools CPR card covering Adults, Child, and Infant (no online CPR classes accepted) U.S. Constitution Requirement: EDUC 850 U.S. Constitution Exam course or approved university course Teaching Requirement: Two (2) years of successful teaching on the basis of the Preliminary DS Teaching Credential in the industry sector(s) listed on the credential. Supervision and Mentoring Requirements: Candidates must be provided continuous advisement and support throughout the CTE credential program by their employer supervisor. Candidates must be observed and provided feedback at least once per course as a requirement of EDUC X309.02-X309.06 using Observation Rubrics provided in each course. DS 6-13 Name (please print) Signature of Preliminary Credential Applicant Name (please print) Signature of Supervisor or HR Representative Date Date Phone # and email
University of California, Riverside Extension Designated Subjects Credential Program Intent to Complete and Clear All Credential Requirements for Bridge CLEAR MS/SS credential holders I agree that I will inform UCR Extension if I change my email address. I agree that I will have daily access to a computer and email. I agree that I have computer literacy skills including the ability to utilize the internet as well as download, print and create PDF documents. (If not, it is recommended that you do not enroll in the program or submit the credential application at this time.) I understand it is my responsibility to enroll in all the required courses. I understand courses can be found in the quarterly catalog or at www.extension.ucr.edu I certify that I understand the requirements that I must complete in order to clear the Preliminary Designated Subjects credential within the 3 year preliminary period as outlined below. Credential Program Coursework Requirements: EDUC 814.7 Orientation: Career Technical Education (non-credit) EDUC X309.08 DS Career Technical Education Core for Single/Multiple Subject Teachers Health Education Requirement: EDUC x451.01 Implementation of Health Instruction Framework for CA Schools or approved university course CPR card covering Adults, Child, and Infant (cannot be expired) U.S. Constitution Requirement: EDUC 850 U.S. Constitution Exam course or approved university course Teaching Requirement: Two (2) years of successful teaching on the basis of the Preliminary DS Teaching Credential in the industry sector(s) listed on the credential. Supervision and Mentoring Requirements: Candidates must be provided continuous advisement and support throughout the CTE credential program by their employer supervisor. Candidates must be observed and provided feedback at least once as a requirement of EDUC X309.058 using the Observation Rubrics provided. Name (please print) Signature of Preliminary Credential Applicant Name (please print) Signature of Supervisor or HR Representative Date Date Phone # and email DS 10-14
SAMPLE WORK VERIFICATION LETTER * * * * S A M P L E O N L Y* * * * Company Letterhead Date: State of California Commission on Teacher Credentialing PO Box 944270 Sacramento CA, 94244-2700 To Whom It May Concern: Please let this letter serve as verification of employment of Candidate s Name at Name of Company during the period of month/day/year to month/day/year. During the above period, Candidate s Name was employed Full-time or Part-time as a Job Title for an average of ## hours per week. In this regard, the nature of his/her duties and responsibilities were as follows: Sincerely, (Signature) Please physically sign, no computer generated signatures will be accepted. Name of Company Representative Title Phone Email Note: A job description can be attached to the letter. * * * * S A M P L E O N L Y* * * *