INTERNSHIP CREDENTIAL APPLICATIONS California State

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INTERNSHIP CREDENTIAL APPLICATIONS California State Powered By Docstoc
					                                                   Fresno State
                                        Application for Intern Credential
                                      *** Instructions - Keep This Sheet ***
Complete the credential application form and submit the appropriate items listed below in one packet to the
Credential Analyst at the Kremen School of Education and Human Development. A valid email address and
credit/debit card are required to apply for your credential.
  I. MULTIPLE or SINGLE SUBJECT or EDUCATION SPECIALIST CHECKLIST
     (CBEST or equivalent basic skills test must have already been passed)
            Copy of current district employment Intern contract/agreement
     ___
            (submit copy only – take original to Intern office)
     ___      Copy of Intern Admission/status letter (submit copy only)
              Copy of Intern Agreement with the School of Education.
     ___
              (submit copy only, - take original to Intern office)
     ___      Current Fresno State unofficial transcripts. Transcripts printed off your portal are acceptable.
              $25.00 money order/cashier’s check payable to “Fresno State”. Print your name and Fresno State
     ___      ID# on the money order/cashier’s check. No personal checks please.

 II. ADMINISTRATIVE SERVICES CHECKLIST - CBEST must have previously been passed.
     ___   Copy of signed agreement form with the School of Education.
     ___      Copy of signed 6 pt Letter of Intent.
     ___      Copy of district employment contract/employment agreement for an administrative position.
     ___      Copy of current basic credential (must not be expired/expiring)
              Original employer letter verifying at least 3 years of experience on a prerequisite teaching or
     ___
              services credential.
              $25.00 money order/cashier’s check payable to “Fresno State”. Print your name and Fresno State
     ___      ID# on the money order/cashier’s check. No personal checks please.
     ___      Transcripts. Unofficial transcripts printed from your my.fresnostate.edu account are acceptable.

III. PPS: SCHOOL PSYCHOLOGY CHECKLIST
     ___    Copy of Certificate of Clearance or emergency permit for fingerprint clearance.
     ___      Copy of CBEST card.
              Copy of district intern contract. If your employer will not issue a contract prior to obtaining the
     ___
              intern credential, you may turn in an employment agreement.
     ___      Copy of internship agreement with the Psychology department.
     ___      Official transcripts verifying your bachelor’s degree in Psychology (if degree not from CSUF).
              $25.00 money order/cashier’s check payable to “Fresno State”. Print your name and Fresno State
     ___      ID# on the money order/cashier’s check. No personal checks please.
     ___      Transcripts. Unofficial transcripts printed from your my.fresnostate.edu account are acceptable.

                                                   Questions?:
                                   Contact the Credential Analyst, Sherri Nakashima
                             at sherrin@csufresno.edu or Education Building, Rm100
                    Once you have submitted a complete application packet to ED100:

1. The Credential Analyst will process your application and send it online to the California Commission on
   Teacher Credentialing. Please allow approximately 2-4 weeks for processing.

2. You will be contacted by the CTC via email to answer questions and provide your payment.

3. Once payment has been received, you will be sent a verification email. You may print this out as proof of
   applying for your credential and submit it to your County Office of Education or wait for your final email
   indicating that you have been credentialed.

4. Within approximately 1-3 weeks of your payment verification you will receive a final email with your document
   number on it. Register this email with your County Office of Education. Once you have received the final email
   your official credential information will be available at: http://www.ctc.ca.gov/




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                                                  Fresno State
                                        Application for Intern Credential
                                                                                Student ID#

                                                                                           SS#            -   -

                                                                                Date of Birth

Name
                Last                                        First                                Middle

Former Names, If Any

Mailing Address:
                             Number, Street, Apt#

                                City                                 State         Zip Code

Telephone:      Home                                Cell                         Work

Email Address                                            *
                *If your employer blocks outside emails, please use your personal email.
                (centralusd.k12.ca.us cannot be used)


    1. BA/BS                              Major
                Date Granted

    2. Type of Credential/Permit currently or previously held:



Please check the credential you are applying for:
____ Multiple Subject (2042):                              BCLAD Spanish ___    BCLAD Hmong ___
____ Single Subject                                        Subject Area
____ Educational Specialist Instruction                    Mild/Moderate ___    Moderate/Severe ___
____ Administrative Services
____ PPS: School Psychology

  Employed By:
  District
  County
  First Day of Internship:


Questions?:
Contact the Credential Analyst, Sherri Nakashima at sherrin@csufresno.edu or Education Building, Rm100

Mailing Address:
Kremen School of Education and Human Development
Fresno State Credential Analyst
5005 N. Maple Avenue, M/S ED701
Fresno, CA 93740-8025


                                                               3
                            OFFICE USE ONLY – DO NOT WRITE ON THIS PAGE

CSU fee ___      FSU transcripts ___     Certificate of Clearance fee ___


            MS/SS/SPED                               ADMIN                                  PSYCH
  Degree ___                            Copy of current credential____         C of C ____
  Constitution ___                      6 pt Letter of Intent ____             District contract ____
  Intern Status Letter ___              District contract ____                 Intern agreement ____
  District contract ____                3 year experience letter ____          Degree _____
  KSOEHD Agreement ___                  Admitted to program ____               CBEST _____
  CSET ___        Fresno State          CBEST____
                  Coursework ____
  Other IHE coursework____
  CBEST ____
  C of C _____

                    Multiple Subject                             Single Subject                 SPED
  CI 171 ___                 CI 175___                     EHD 155A ___                 SPED 120 ___
  LEE 172 ___                CI 176 ___                    CI 151 ___                   LEE 172 ____ if needed
  LEE 173 ___                LEE 177 ___                   CI 152 ___
  EHD 174 ___                EHD 178 ___                   CI 159 ___

BCLAD Spanish:      Span 118/121___     Span 122/119___     Span 104/134 ___      CLS 116 ___    LEE 139/136 ___
LEE 133/144___
BCLAD Hmong:        Hmg 100___       Hmg 101___    Hmg 104/LEE 129 ___         Anthro 123___    LEE 139/135 ___
LEE 133/144___


Date App Sent To CTC: __________________                   Status Date/Date CTC Issued:_____________________
Issuance Date: _________________________                   Expiration Date:________________________

Intern Multiple Subject:               BCLAD Spanish ___            BCLAD Hmong ___
Intern Single Subject                  Subject Area: ______________________________
Intern Education Specialist (1059)     Mild/Mod___                  Mod/Severe___         DHH___
Intern Administrative Services
Intern PPS School Psychology

  District:                                                  County:

  CDS Code:                                                  semester completed

Input Into PS

Input Into KDB




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