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Application for Credential - University of Redlands

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					                                                                             Reading Certificate




                 Electronic Submission of Credential Application

  The online application and recommendation is a two-step process; the
  University of Redlands Credential Analyst will enter the data necessary to
  recommend you for the credential. Once that information is entered into
  the CTC (California Commission on Teacher Credentialing) system, an
  email is sent to you, from CTC, requesting that you complete the credential
  application form and pay the application fee ($57) by credit card
  (containing a VISA or MASTERCARD logo). Instructions for completing
  the credential application and paying the fee will be included in the email
  you receive from CTC.

  Once you have completed this task, CTC will send an email to you and the
  University of Redlands Credential Analyst which will confirm that you
  have been recommended for a credential. You can use this confirmation as
  the C-19 letter requested by your employing district. Your file at CTC will
  be downloaded on a daily basis. CTC will then process the data and grant
  a credential within one or two days of receipt. You will receive another
  email from CTC when your credential is issued. You will not receive a
  printed document from CTC. Their website is the official site for all
  credentials and permits. You can download a copy of your credential from
  the site.

  This process requires that you have a valid, permanent email address and a
  credit card.

  NOTE: We are unable to process your credential application if your
  Student Accounts balance is not current. You can call the Business
  Office, Student Accounts, 909-748-8190 to check the status of your
  account.

            Complete information on the next page and submit to the
                   School of Education, Credential Analyst
    03/09




1200 East Colton Avenue PO Box 3080  Redlands, CA 92373-0999  Tel: 909-748-8064  Fax: 909-335-5204
                                        www.redlands.edu/soe
                                Application for the Reading Certificate
    To be eligible for The Reading Certificate, you must have served a minimum of
three years of successful experience in a full-time position in a public school, or
private school of equivalent status, while holding a teaching credential. Please
attach the completed (by your school district’s HR office) form CL-41 EXP, to this
application.

                                            Type or Print Only

    1.
                                                                                    Instructions
         Full Legal Name: First, Middle, Last
                                                                      To use this document, please SAVE it
    2.          -       -                                             to your personal computer, Flash-
                                                                      Drive, or email account. Use the TAB,
         Social Security Number                                       ARROW keys or MOUSE to navigate
                                                                      to different cells. Cells are ACTIVE
    3. Date of Birth:                -          -                     When they are DARKENED. Use
                                                                      your MOUSE on the Pull-Down
                                Month    Date       Year              Menus. When completed, print a copy
                                                                      and have all SIGNATURE lines Signed
    4.                                                                in Blue or Black ink.
         Mailing Address                                              When completed return to the
                                                                      University of Redlands, Credential
                ,           ,                                         Analyst.
         City, State, Zip Code
    5. Former / Maiden Name 1:
         Former / Maiden Name 2:
         Former / Maiden Name(s): First, Middle, Last
    6. Home Phone: (                )       -
    7. Work Phone: (                )       -
    8.
         Permanent Email Address
    9. Signature:__________________________________ Date:______________________
         (Signatures are required in BLUE or BLACK INK – Print the document and then sign it)
    10. Name of Credential:_____READING CERTIFICATE____________________________
                                RETURN TO UNIVERSITY OF REDLANDS



State of California                                                              Telephone
California Commission on Teacher Credentialing                                   (916) 445-7254 or (888) 921-2682
Box 944270                                                                       E-mail: credentials@ctc.ca.gov
1900 Capitol Avenue                                                              Web Site: www.ctc.ca.gov
Sacramento, CA 94244-2700


                                      VERIFICATION OF EXPERIENCE

If experience is a requirement for your credential, please have the experience verified by your current and/or
previous employer using this form. You only need to verify experience that is appropriate for the issuance of this
credential. If you have served in more than one position for a single employer, have a separate form completed
for each position that you held.

→ Do not mail this form directly to the Commission

This is to certify that:                 _________________________________________ (name of applicant)
has served satisfactorily from:          ___________(mm/yy) to____________(mm/yy)
in the position of:                      _________________________________________
in the following grade or level:         _________________________________________
in an area or subject of:                _________________________________________
Circle One:           Full-Time                  Part-Time    Day-to-Day Substitute
(If Part-Time is selected, please specify __________hours/day and __________days/week
School / Agency:               __________________________________________________
Address:                       __________________________________________________
                               __________________________________________________
Telephone Number:              __________________________________________________


Verified By:_______________________________________________
           (Signatures are required in BLUE or BLACK INK – Print the document and then sign it)

Name: __________________________________________________
Title:     __________________________________________________
Date:      __________________________________________________


                                     RETURN TO UNIVERSITY OF REDLANDS




CL-41

				
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