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					CALIFORNIA STATE UNIVERSITY MONTEREY BAY PROGRAM APPLICATION SINGLE SUBJECT TEACHER CREDENTIALING PROGRAM ELA OR BCLAD EMPHASIS Please Print or Type All Information Name:
(Last) (First) (Middle) (Maiden)

Applying for _____________
Semester

______
Year

Subject area:

_____________

Emphasis:
ELA or BCLAD

English, Math, Science, Social Science, Foreign Language

Are you applying for the Internship Program (CTIP)? ________ In order for you to be admitted to the Internship Program, we must confirm that you have obtained a position as a regular (not a substitute) teacher in a public school district. Contracting School: ___________________________________________ Principal:____________________________________ Address: School District: ___________________________________________ Phone: ____________________________________

___________________________________________ County: ____________________________________

Contact Information
Address:
(Street) (City) (State) (Zip)

Home Phone: Permanent Address:
(Street)

Work Phone:

E-mail:__________________________________

(City)

(State)

(Zip)

Permanent Phone:

___

Permanent Contact Name: ___________________________________

Single Subject Program Application November 2008

Name _____________________________________________ Single Subject Teacher Preparation Program

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Confidential Information
ID #:
(We must have your Social Security #)

Date of Birth:
(Requested for statistical reporting purposes only)

Gender:

M

F

Ethnic Identity
Optional. Requested for reporting purposes only. l: (i.e. African American, American Indian, Euro American, Hispanic, etc.)

Education: You are required to send one two sets of official transcripts: one with your Graduate Application for Admission to the
Office of Admissions and Records; and one with this Program Application to the Program Coordinator.One of these sets will eventually To speed up the application process, please attach a set of transcripts (official or unofficial) directly to this supplementary application form. Remember that the official transcripts must be on file with the Office of Admissions and Records before we can officially admit you.

A. Universities/Colleges Attended and Degree Information. If you have attended more than two universities/colleges,
append the additional information to the end of this application. University/College Name : Type Degree Awarded: Academic Major: Location:
City, State

Date:
If CSUMB graduate, a copy of “Advisor’s Final Degree Form” is required)

GPA:

University/College Name : Type Degree Awarded: Academic Major:

Location:
City, State

Date: GPA:

Name _____________________________________________ Single Subject Teacher Preparation Program

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B. CALIFORNIA BASIC EDUCATIONAL SKILLS TEST (CBEST):
__________ Date exam taken -- attach official score report (Required for admission to the Professional Phase of the Program) __________ Date exam passed -- attach a copy of the Certificate (You must have passed all sections of the CBEST exam before you can begin advanced student teaching as well as to be eligible for the Internship Program.)

C.

SUBJECT MATTER COMPETENCE: You must have passed the Subject Matter Competence Requirement to be

admitted to the Program and to be eligible for the Internship Program. APPROVED PROGRAM (also known as a “waiver” program)? ________ Attach a copy of the official letter or certificate. yes or no SUBJECT: _________________________________ OR COLLEGE/UNIVERSITY: _________________________________

EXAM for Subject Area (SEE Handbook pp 23-25):(If taken, attach copies of personal score report mailed to you) Sections Taken:_______________ (English, Math, Science, Social Science, Foreign Language) _______________ _______________ _________________ Date(s) Passed:_______________ _______________ _______________ _________________

CSET Exam:______________________

OR Subject matter competence exams prior to January 2003: SSAT Exam:______________________
(Subject Area)

Date(s) Taken:_______________ Date(s) Taken:_______________ _______________ _______________

Date(s) Passed:_______________ Date(s) Passed:_______________ _______________ _______________

PRAXIS II Exams:______________________
(Subject Are

Name _____________________________________________ Single Subject Teacher Preparation Program

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If you have not taken the CSET when do you plan to take it? If you have registered for these examinations, please attach copies of the registration forms or your tickets of admission.

Is there anything else we need to know about your subject matter competence?

D. PREREQUISITE COURSES (Required for admission to the Professional Phase of the Program): U.S. Constitution, 3
units of a single foreign language. You will complete these courses as needed during the Pre Professional Phase of the program. (The required Introduction to Teaching course usually is completed just prior to or at the time of beginning the Professional Phase of the Program.) Requirement U.S. Constitution (3 units)_ Foreign Language (3 units) Preliminary Placement (3 units) ___________________________ _ _ Course Name Course Number _ _ _ _ University/College_______ _ _______________ _______________ _________________________

Name _____________________________________________ Single Subject Teacher Preparation Program

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EXPERIENCE WORKING WITH YOUTH OR CHILDREN: List below your experiences working with children or youth in
chronological order, beginning with the most recent. If necessary, attach another sheet:
Date From - To Description & Location Name of Supervisor Name of Site Telephone Number Paid? Yes No

OTHER EXPERIENCES OR SKILLS THAT ENHANCE WORKING WITH YOUTH OR CHILDREN.
For each category, list the appropriate activities and dates. (a) Extracurricular and Community Involvement. If necessary, attach another sheet:

(b) Special skills and experiences: technical, clerical, computer, mechanical, performing arts, arts and/or crafts, etc. Also, list travel or residence outside your current residence area. If necessary, attach another sheet.

Name _____________________________________________ Single Subject Teacher Preparation Program (c) Language(s) other than English (e.g. Spanish, Chinese, American Sign Language, etc.). If necessary, attach another sheet.

6

Language ___________________________________________________ (Indicate levels below)
LIMITED FAIR OR MODERATE FLUENT

SPEAKING READING WRITING LISTENING

Name _____________________________________________ Single Subject Teacher Preparation Program

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ESSAY QUESTION:
TYPE your response (one or two pages, double spaced) to the following on a separate sheet of paper and attach it to the application.

1. Why do you want to be a teacher? What has led you to this decision? How do you, as a teacher, hope to make a difference?

REFERENCES: (See the forms provided on pages 9, 10, and 11 of this application form.)
You must obtain three letters of reference, preferably from people who can attest to the nature and quality of one or more of the experiences working with youth or children that you have listed above. These references must be mailed by the person directly to the university. List below the names and telephone numbers of the persons from whom we may expect letters, as well as the dates you contacted them requesting the letter.

Name

Phone Number

Date Contacted

________________________________________________________________________________________

Name _____________________________________________ Single Subject Teacher Preparation Program

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RELEASE OF INFORMATION. I authorize the release of information regarding my credential status to the following: CSUMB
Institute for Field-Based Education faculty and staff, school districts, County School of Education offices, the Commission on Teacher Credentialing, other colleges and universities.

Signature

Date

All applications and correspondence submitted becomes the property of CSUMB. Please make copies before submission.

PLEASE MAIL THIS PROGRAM APPLICATION TO
Dr. Beverly Carter Single Subject Program CSU Monterey Bay 100 Campus Center, Building 03 Seaside, CA 93955-8001

AND
MAIL (OR COMPLETE ON-LINE) THE CSU GRADUATE/POST BACCALAUREATE APPLICATION (follow instructions about where to send and be sure to include the application fee).
Be sure both applications are complete. Test score reports and supporting materials must be complete before the application will be reviewed for admission. Arrange to have two individually sealed official sets of transcripts from each college or university attended (to include degree earned and date awarded).mailed directly to CSUMB: one to the Office of Admissions and Records; and one to the Program Coordinator. Have your transcripts sent immediately; this is a slow process. In the meantime, it will speed up the application process if you can attach unofficial copies of your transcripts directly to your Supplementary Application form. Remember that the official transcripts will need to be on file with the CSUMB Office of Admissions and Records before we can officially admit you. For information, call Beverly Carter at (831) 582-5024.

Name _____________________________________________ Single Subject Teacher Preparation Program

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CALIFORNIA STATE UNIVERSITY MONTEREY BAY LETTER OF RECOMMENDATION
Name of Applicant _______________________________________________________________________________________________________
Last First Middle Social Security Number

Applicant: Before you give this form to a person acquainted with your qualifications for postgraduate work and becoming a classroom teacher, please check and sign, in accordance with the Family Educational Rights and Privacy Act of 1974. ( ) hereby waive I my right of access to this letter of recommendation. ( ) do not waive ____________________________________________________________________________ Applicant Signature Date ========================================================================================================= To Writers of Letters of Recommendation: Please answer the following questions. Use the reverse side or attach a separate page. 1. In what capacity and how long have you known this applicant? 2. Have you seen this applicant working with youth or children? If so, describe how often and the setting, e.g. substitute teacher, recreation leader, tutoring, etc.) 3. Based on your direct knowledge, what qualities and skills does the applicant possess that would lead you to believe that he/she would be a successful middle school or high school teacher? Type or print name _____________________________________ Signature _____________________________________________ Date ______________________________________ Position____________________________________

Address ______________________________________________________________________________________________ The person writing this recommendation should mail this letter directly to: Dr. Beverly Carter Single Subject Program CSU Monterey Bay 100 Campus Center, Building 03 Seaside, CA 93955-8001

Name _____________________________________________ 10 Single Subject Teacher Preparation Program CALIFORNIA STATE UNIVERSITY MONTEREY BAY LETTER OF RECOMMENDATION Name of Applicant _______________________________________________________________________________________________________
Last First Middle Social Security Number

Applicant: Before you give this form to a person acquainted with your qualifications for postgraduate work and becoming a classroom teacher, please check and sign, in accordance with the Family Educational Rights and Privacy Act of 1974. ( ) hereby waive I my right of access to this letter of recommendation. ( ) do not waive ____________________________________________________________________________ Applicant Signature Date ========================================================================================================= To Writers of Letters of Recommendation: Please answer the following questions. Use the reverse side or attach a separate page. 1. In what capacity and how long have you known this applicant? 2. Have you seen this applicant working with youth or children? If so, describe how often and the setting, e.g. substitute teacher, recreation leader, tutoring, etc.) 3. Based on your direct knowledge, what qualities and skills does the applicant possess that would lead you to believe that he/she would be a successful middle school or high school teacher? Type or print name _____________________________________ Signature _____________________________________________ Date ______________________________________ Position____________________________________

Address ______________________________________________________________________________________________ The person writing this recommendation should mail this letter directly to: Dr. Beverly Carter Single Subject Program CSU Monterey Bay 100 Campus Center, Building 03 Seaside, CA 93955-8001

Name _____________________________________________ 11 Single Subject Teacher Preparation Program

CALIFORNIA STATE UNIVERSITY MONTEREY BAY LETTER OF RECOMMENDATION Name of Applicant _______________________________________________________________________________________________________
Last First Middle Social Security Number

Applicant: Before you give this form to a person acquainted with your qualifications for postgraduate work and becoming a classroom teacher, please check and sign, in accordance with the Family Educational Rights and Privacy Act of 1974. ( ) hereby waive I my right of access to this letter of recommendation. ( ) do not waive ____________________________________________________________________________ Applicant Signature Date ========================================================================================================= To Writers of Letters of Recommendation: Please answer the following questions. Use the reverse side or attach a separate page. 1. In what capacity and how long have you known this applicant? 2. Have you seen this applicant working with youth or children? If so, describe how often and the setting, e.g. substitute teacher, recreation leader, tutoring, etc.) 3. Based on your direct knowledge, what qualities and skills does the applicant possess that would lead you to believe that he/she would be a successful middle school or high school teacher? Type or print name _____________________________________ Signature _____________________________________________ Date ______________________________________ Position____________________________________

Address ______________________________________________________________________________________________ The person writing this recommendation should mail this letter directly to: Dr. Beverly Carter Single Subject Program CSU Monterey Bay 100 Campus Center, Building 03 Seaside, CA 93955-8001

X-D-10 9/95

CBEST
TAPE OR STAPLE VERIFICATION TRANSCRIPT HERE

APPLICANT MUST SUBMIT ORIGINAL TRANSCRIPT

STATE OF CALIFORNIA COMMISSION ON TEACHER CREDENTIALING CL-679 3/92


				
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