MULTIPLE SUBJECT CREDENTIAL with MIDDLE LEVEL CERTIFICATE

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					         MULTIPLE SUBJECT CREDENTIAL with MIDDLE LEVEL CERTIFICATE
.
                           PROGRAM APPLICATION
                                Fall 2009
    College of Education Application Fee: $25.00 (make checks payable to CSUSM)
                                               Supplementary Authorizations and Subject Matter Authorizations are available.
                                               Please list Supplementary Authorizations or Subject Matter Authorizations in
                                               subjects that you may be interested in teaching. Please refer to Part III, Section 5
                  Full-Time Day                of this application for more information
                                                 1.
                                                 2.



                                Please indicate if you are applying for the BCLAD Emphasis: Spanish
          BCLAD              The BCLAD Emphasis: Spanish is available with all Cal State credential programs.

                          All programs include authorization to teach second language learners.



CSUSM Student ID No. (if available):

Social Security No.                                                       Date of Birth:


Name
           Last                                    First                      Middle                    Maiden/Former


Address
              Street


           City                                                       State                       ZIP


Home Phone:        (    )                                             Cell Phone:       (     )
                   (include area code)                                                       (include area code)

Email address:                                                                          Gender:         Male        Female
                   Please print clearly


Return application to:
    College of Education, Student Services Center             Application Filing Period: January 15 – March 15, 2009
    University Hall, 221                                             PRIORITY DEADLINE: March 15, 2009
    San Marcos, CA 92096
    760/750-4277
      www.csusm.edu/coe                                                                                                  Page 1 of 10
Optional: Ethnic Identity                                             I am a CSUSM Graduate          Yes        No
                            (used for state reporting only)


PART I- ADMISSION DOCUMENTS

    Graduate Application: Complete graduate application and submit directly to the Office of Admissions or apply
    online at www.csumentor.edu no later than March 15, 2009 deadline.

        Application submitted             Date submitted:

     Arrange to have official transcripts mailed directly to the Office of Admissions from each college or university listed
     above, including an official transcript with your degree posted and date awarded. NOTE: Matriculated CSUSM
     students already have transcripts on file and do not need to submit.




PART II - PREREQUISITE COURSES – Must be completed prior the beginning the program
    Prerequisite Courses in Education

         Education 350 - Foundations of Teaching as a Profession

          Completed at CSU San Marcos -- Semester completed                             Instructor

          In progress at CSU San Marcos -- Anticipated completion                       Instructor

          Equivalent course completed OR in progress at

         Year/Semester completed or anticipated completion

         Education 364 - Cultural Diversity and Schooling

          Completed at CSU San Marcos -- Semester completed                             Instructor

          In progress at CSU San Marcos -- Anticipated completion                       Instructor

          Equivalent course completed OR in progress at

         Year/Semester completed or anticipated completion


         Education 422 – Technology Tools for Teaching & Learning

          Completed at CSU San Marcos -- Semester completed                             Instructor

          In progress at CSU San Marcos -- Anticipated completion                       Instructor

          Equivalent course completed OR in progress at

         Year/Semester completed or anticipated completion


      Official transcripts verifying ALL prerequisites has been submitted or will be submitted as soon as available.




                                                                                                               Page 2 of 10
PART III – EXAMS/ BASIC SKILLS EXAMINATION

 Basic Skills Examination(CBEST) – All applicants must take either CBEST or the CSET Writing Skills Examination (test
code 142) prior to admission to the program. Please note: Conditional admissions will be considered on a limited basis;
however, state program standards prohibit advanced student teaching until Basic Skills Examination is passed. If you
did not submit your scores electronically to CSUSM, in addition to the copy you include on your admissions,
you will need to submit an official score.

Exam options:

    a)       Pass all three subtests of the CSET Multiple Subject examination in addition to the CSET Writing Skills Examination. The new CSET: Writing
    Skills test is part of a new option for credential candidates to meet the state basic skills requirement. This option is available only to candidates who are planning
    to earn a Multiple Subjects credential. Candidates who have already passed the CBEST do not need to take the CSET: Writing Skills examination.

                  CSET: Writing Skills           Expository Writing; Expressive Writing                            Test Code 142
                                                                          OR
    b)      CBEST (California Basic Skills Examination)

                  Information, test preparation and registration for CSET and CBEST is available online at: www.ctcexams.nesinc.com


         CBEST has been taken, and a copy of the entire score sheet indicating my test scores is attached.
          A copy is required even if you requested your scores to be reported to CSUSM.

         CBEST was taken on                             , and a copy of the entire score sheet indicating my test scores
    will be submitted as soon as received.
          A copy is required even if you requested your scores to be reported to CSUSM.

        CBEST exam will be taken on                           , and a copy of the entire score sheet indicating my test
    scores will be submitted as soon as received.
         A copy is required even if you requested your scores to be reported to CSUSM.
            You must also submit a copy of your CBEST registration ticket with your application

Subject Matter Competency Exam(CSET).                     All candidates must pass the California Subject Examinations for Teachers
(CSET): Multiple Subjects prior to admission to the program. PLEASE Note: Conditional admissions will be considered on a limited basis;
however, state program standards prohibit advanced student teaching until CSET: Multiple Subjects is passed.

         CSET has been taken, and a copy is included.
                     OR
         CSET exam will be taken on                                                        Please include your registration ticket.

    Original test scores are required even if you requested your scores to be reported to CSUSM.

    MSAT scores are acceptable for certification if passed within five (5) years of the individual test date.
                You must also submit a copy of your CSET registration ticket with your application.

         Certification to Teach Departmentally in a Subject. It is recommended students obtain certification to teach
         departmentally in a subject area. There are three options available to obtain certification to teach departmentally:

         a. State-approved examination in a single subject content area. Refer to Table 3 and 4 in the Multiple Subject Credential
         Program with Middle Level Certificate Brochure for information on CSET. Please call (760) 750-4277 for further information.

         b. Single Subject Waiver Program in Social Science, Mathematics, English or Spanish from CSUSM. Waiver programs from
         other Universities are also acceptable.

         c. Supplementary Authorization or Subject Matter Authorization: The California Commission on Teacher Credentialing (CCTC)
             established the Subject Matter authorization as an alternative method of demonstrating single subject content knowledge.
             Please refer to www.csusm.edu for details on the authorizations. Please call (760) 750-4277 to sign up for a workshop on
             Supplementary Authorizations and Subject Matter Authorizations.



                                                                                                                                                       Page 3 of 10
            Options a and b qualify students for the Single Subject Credential upon successful completion of the Multiple Subject
                                               Credential Program with Middle Level Certification.

FOR BCLAD: Spanish Emphasis Candidates Only: Oral and Written Second Language Assessment. An assessment
will be arranged after the application deadline or the applicant may take the CSET: Spanish, subtest III (test code-147)
Examination (attach official test results). Please contact the Testing Center (760/750-4020) to arrange an assessment.
(You will receive your assessment results by mail as soon as they are available to us.) There will be a fee of $50.00
per assessment ($50.00 for written assessment and $50.00 for oral assessment). Please refer to program brochure for all
BCLAD requirements.




PART IV - ADDITIONAL ADMISSION DOCUMENTS
    Three Letters of Recommendation from faculty or others who are knowledgeable about your personal qualities and
    potential are required. One letter must be from a public school teacher on letterhead stationary Letters of
    recommendation are non-confidential and should be removed from envelopes.

         Included

         To follow

    Fingerprint Clearance
    Instructions on applying for a Certificate of Clearance may be found at:
    http://www.csusm.edu/coe/FormsPolicies/index.html


          Online Application for Certificate of Clearance submitted on

         A copy of emergency permit is included.


      NOTE: You will not be admitted to a credential program without proof that you have submitted the required
            verification of fingerprint clearance.

    Tuberculin Clearance. This is different than the proof of immunization required for admission to the
    University. TB clearance is required prior to admission to the credential program.

         Copy of TB Results is attached.

         To follow.




PART V- INTERVIEW
    PLEASE NOTE: An interview for qualified candidates is required. Information regarding interviews will be
    mailed to you after the application deadline. Expect to receive an interview letter in late March or early April. A
    writing prompt will be required in addition to the interview.




                                                                                                                       Page 4 of 10
If you have a disability and will need reasonable accommodations to take part in the interview and/or admissions process for an
academic program within the College of Education, please contact Disabled Student Services at 760/750-4905 or by email at
dss@csusm.edu. Specific questions regarding the application and interview process for any of the College of Education programs
should be directed to Student Services Center at 760/750-4277


PART VI- COREQUISITE REQUIREMENTS

Co-requisites are requirements that can be completed during a credential program but MUST be
completed before issuance of a preliminary credential.

     U.S. Constitution (college level course or exam) – All applicants must complete this requirement to be
     recommended for credential. If you are applying for an internship this requirement must be completed before intern
     teaching.

    Please refer to your official transcripts and complete all appropriate blanks.

          Completed at/In Progress at                                                            (college/university)

          Semester/Year completed

          Course number:


          Exam is to be taken. Submit original letter for your file as soon as available.

     Health Education Requirement (college level course) All applicants must complete this requirement to be
     recommended for credential. The course must cover:
           a. Nutrition
           b. Physiological and sociological effects of abuse of alcohol, narcotics and drugs
           c. Use of tobacco

          Completed at/In Progress at                                                            (college/university)

          Semester/Year completed

          Course number:


  Once you complete any work in progress at an institution other than CSUSM, you must mail official transcripts directly to
  the university.

     CPR Certification: Prior to issuance of initial credential, CPR Certification must be completed which covers infant,
     child, and adult. You must submit a photocopy (front and back) of your CPR card to the Student Services Center and
     be prepared to show the original document.



COREQUISITE EXAM – RICA (exam to be taken during credential program)

  The California Commission on Teacher Credentialing requires passing the Reading Instruction Competence
  Assessment (RICA) before recommendation for credential. You are not eligible to take RICA until you complete
  EDMI 522 in the program. Please contact the College of Education Student Services Center for more information.




                                                                                                                     Page 5 of 10
Transcripts:
Please list all colleges and universities attended and include copies of all official transcripts. It is not necessary to submit
transcripts from CSUSM. These transcripts are in addition to the ones sent to university admissions

    Name of Institution                                               Dates of Attendance/Graduation




     University where bachelor’s degree was granted:

     Academic major

     Date of degree or anticipated date of completion


                              COLLEGE OF EDUCATION FILES MUST BE COMPLETE 10 DAYS
                          AFTER THE APPLICATION DEADLINE TO RECEIVE FULL CONSIDERATION.




  MY SIGNATURE BELOW CONFIRMS THAT EACH OF THE PROGRAM REQUIREMENTS FOR
               ADMISSION HAS BEEN OR IS BEING COMPLETED AS INDICATED.


Signature                                                                              Date


HOW DID YOU HEAR ABOUT THE CREDENTIAL PROGRAM?
  Advising Session
  Website
  Outreach/Recruitment

     Other (Friend, teacher, student, advertisement, etc.)




                                                                                                                  Page 6 of 10
     PERMISSION TO COMMUNICATE ACADEMIC AND DISPOSITIONAL GROWTH AND
      DEVELOPMENT CREDENTIAL AND MASTER’S COURSES / CLINICAL PRACTICE


   The College of Education considers many aspects of a person’s continuation in credential and degree
   programs and placement in clinical practice experiences. In order to fairly evaluate teacher candidates and
   support their preparation for careers in education, we use a variety of data to gain a sense of the academic
   and professional performance of the teacher candidate. To protect the teacher candidate’s right to privacy,
   we seek your permission to freely communicate to program coordinators and faculty about your progress in
   a program course or clinical practice. If for any reason you do not wish such information to be shared,
   please indicate below.



Check one:
                      I give my permission for instructors to communicate concerning
                     my academic and/or professional performance and development
                     during my enrollment at California State University San Marcos.



                     I do not give my permission for instructors to communicate
                     concerning my academic and/or professional performance and
                     development during my enrollment at California State University
                     San Marcos.*



 *In the event the teacher candidate does not want to have her/his information shared amongst faculty and
 program coordinators, instructors in prerequisite courses will share feedback and/or concerns with the
 Associate Dean of the College of Education.



 TEACHER CANDIDATE (PRINT NAME)


 Teacher Candidate Signature                                        Date




                                                                                                    Page 7 of 10
                                                 Media Release Form
                                                        College of Education




As a part of the CSUSM Teacher Credential and Masters programs, videotaping of teaching performance is often required for the
purpose of assessment. Additionally, still images are frequently taken to document candidate accomplishments and special events.
The purpose of this release is to inform you of the purposes for capturing the images and the intended use.



I,                                                 , do hereby give the California State University San Marcos, College of
Education, the irrevocable right to use my image in still or video form for the purpose of assessing my progress in the program
as well as to publicize accomplishments of teacher candidates in print, video, and Web-based media.

I HAVE READ THIS RELEASE AND FULLY UNDERSTAND ITS CONTENTS.

CSUSM Teacher Candidate (Print)

CSUSM Teacher Candidate (Signature):

Date Signed:

CSUSM ID Number:




If you do NOT want your image accessible for assessment or acknowledgement purposes, please sign below. If video has been
assigned for assessment purposes, you will have to take alternative arrangements to meet the necessary requirements.


CSUSM Teacher Candidate (Print)

CSUSM Teacher Candidate (Signature):

Date Signed:

CSUSM ID Number



                    PLEASE RETURN THIS FORM AT ORIENTATION




                                                                                                                     Page 8 of 10
        FOR USE IN COMPLETING THE UNIVERSITY APPLICATION




1. Graduate application for Cal State University San Marcos – submitted to the university online:
   www.csumentor.edu. If this is the first time you have created an account, please write down your user
   name and password for future use. A $55 fee is required to submit this application. These tips on properly
   completing application fields will assure success in the application process:

          Major/Program objective; CREDENTIAL ONLY
          Degree objective: NONE
          Education credential objective: Applying to a credential program now
           o Program choices: on drop-down menus list MA and Multiple Subject (or Single Subject,
               or Special    Education, depending on which credential program you wish to enter)
         You do not need to provide the following information on this application (SKIP THESE
           SECTIONS):
           o EMPLOYMENT Information/History
           o Academic Honors
           o Test Information
           o References
         When asked for a Statement of Purpose, simply put, “N/A.” This will allow you to move
           forward in the application.




                                                                                                   Page 9 of 10
FINGERPRINT AND TB CLEARANCE



As a part of CSUSM’s legal agreements with school districts and the
liability issues associated with working on school sites, I understand that I
must have fingerprint and TB clearances prior to registering for student
teaching.

I understand that I will NOT be able to register for classes if I have
not received fingerprint and TB clearances.


Print Name



Signature

_________________________
Date




                                                                     Page 10 of 10