RH/KB/4-1-08

California State University, Stanislaus Department of Teacher Education

Single Subject Credential Program

2042 Authorization (CLAD is embedded)

Application

For Academic Year 2008 to 2009

See also the SSCP Advising Packet

Dates to apply: For Spring 2009 start: applications accepted Sept. 4, 2008 to Oct. 24, 2008 For Fall 2009 start: applications accepted Feb. 16, 2009 to Mar. 13, 2009 Turn in Applications to: Credential Processing Center, Room DBH 303, CSU Stanislaus (Turlock) or the Stockton Center for CSU Stanislaus Contact people and offices: SSCP Coordinator: Ms. Robin Hennings (rhennings@csustan.edu, 664-6740) SSCP Coordinator: Ms. Karen Breshears (kbreshears@csustan.edu, 664-6732) Department of Teacher Education: 667-3357 Stockton campus: 467-5300 Stockton Intern Advisor: Dr. Mary Salisbury (msalisbury@csustan.edu, 664-6720 Credential Processing Center: 667-3534 Graduate Office: 667-3129 Financial Aid and Scholarships: 667-3336 California Commission on Teacher Credentialing: ctc.ca.gov California Department of Education: cde.ca.gov

RH/KB/4-1-08

Application Packet Checklist

Before you turn in the application, double check to make sure all the items are enclosed in the order listed. The “A” column is for the Applicant to check. The “O” column is for the Credentials Office to check.

A O

Form I: Information sheet with attached Credential Program Application Receipt for $30 from Cashiers Office (Code 1409) *$30 fee is not applicable to CSU, Stanislaus Alumni

Form II: Autobiographical Statement of Intent Form III: Ethnic Identity (optional) Form IV: Four letters of recommendation from professors, supervisors, school

administrators, teachers, or others who can speak to your suitability to teach adolescents.

Form V: Subject Matter Preparation Verification Form VI: CBEST Verification Form VII: TB Clearance Verification (no more than four years old) Form VIII: Verification of 45 hours of observation in public secondary schools Form IX: Technology Proficiency Verification

Office notes:

Supporting Documentation A O

Verification of application for admission to CSU Stanislaus through the Graduate Office

One set of official (sealed and unopened) transcripts from all institutions of higher education attended other than CSU Stanislaus. Also, include high school transcripts IF using them to meet Constitution or second language acquisition requirement.

Livescan Form (41-LS) copy 2 ONLINE: Application for Character and Identification form. Go to

https://teachercred.ctc.ca.gov/teachers/index.jsp. CLICK ON “Direct Application (non-recommendation Only)” Using a VISA or MasterCard debit or credit card, pay the $29.50 fee. An email will be sent immediately following the successful submission of the application. PRINT OUT THIS EMAIL AND PLACE IN YOUR CREDENTIAL APPLICATION FOLDER AS PROOF THAT YOU HAVE COMPLETED THIS STEP.

Optional: letter indicating reasons for exception to GPA or other admission criteria, if needed.

Office notes:

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Form I

Information Sheet

Name: Date: Last First MI Mailing address: Street City State Zip Home phone: (______) Cell/other phone: (_____) Email: Social Security Number: Please note: this information is how the credentials office gets in touch with you. If any of this information changes, contact the credentials office at 667-3534 or DBH 303.

Circle the applicable response

1. Program option: Student Teacher Field Site Intern Cohort Either 2. Semester/year to begin: Spring 2009 Fall 2009 Other: 3. Will you seek Spanish bilingual certification ?: Yes No (BCLAD) 4. Have you ever been convicted or ever pleaded “nolo contendere” for any violation of the law other than minor traffic offenses? If yes, please check with the SSCP coordinator for procedures.

Yes No 5. Will you be able to participate in a full time, field centered program for the public school year, Monday through Friday? Yes No 6. Undergraduate major: Desired teaching content area: 7. List every Junior College/Community College, College, and University you have ever attended

(including CSU Stanislaus)

Name of College/Universtiy Dates attended From To

From To

From To

From To

From To

From To

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Please complete the following table, indicating prerequisite course information and experiences below. If you have taken classes you think are equivalent, obtain an SSCP Equivalence Form from the Department of Teacher Education, complete the form according to directions, and turn it in to the SSCP Coordinator.

Prerequisitecourses Dept code, Course number, and name

School where taken

Semester and year taken or to be taken

Grade or score

Upper Division Writing U.S. Constitution Co-requisite courses (Strongly recommend to be taken prior to starting program)

EDSC 3900 Foundations of Secondary Education

PSYC/CDEV 3240 Adolescent Growth and Development

Prerequisiteexperiences Circle the way you met the requirement

Subject Matter Preparation (see form V)

CSET Subject matter prep program

CBEST (see Form VI)

Passed

45 hours of observation in public secondary schools (see Form VIII

Documentation Coursework

Technology Proficiency (see Form IX)

Course (specify):_______________________ Documentation

Second language acquisition

3 semester units in college

1 year in high school (high school transcripts required) Life experience (provide documentation)

HILT (provide certificate of completion)

Language Proficiency Exam (BCLAD only) Date passed

Verification

I certify that I have read all the information in the SSCP application packet and SSCP advising packet. I agree to abide by all the policies and procedures of the Single Subject Credential Program. I will attend all the orientation meetings for SSCP. I agree to inform the Credentials Office of any information pertinent to my status as a student in the credential program, including change of name, address, phone number, or email. I authorize CSU Stanislaus to release any information from my records, which is needed by the California Commission on Teaching Credentialing (CCTC), and/or school district where I might teach, to determine my fitness and/or eligibility to teach. I certify that all the information submitted in this application is correct.

Signature Printed Name Date

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Form II

Autobiographical Statement of Intent

Using acceptable essay form, describe: (1) your background in terms of coursework and activities directly relevant to teaching; (2) the aptitudes and skills you have which you feel will help you in your selected profession; (3) the strength of your commitment to the teaching profession; and (4) what you believe you need to learn in the program to prepare you for teaching. Type your essay using 12 font and 1 1/2 spacing. Your writing skills as well as the content of your essay will be evaluated as part of the selection process. (One to two pages long.)

Form III

Ethnic Identity (optional)

Name: _______________________________________________ Gender: Last First Please enter a code from the list below in the box:

1.American Indian or Alaska native; tribe: ________________

J. Japanese 6. Other Pacific Islander

2.Black, non-Hispanic, including African American

F. Filipino R. Asian Indian

3. Mexican-American, Mexican, Chicano

C. Chinese M. Cambodian

A. Central American K. Korean L. Laotian B. South American 5. Other Asian V. Vietnamese Q. Cuban D. Decline to state T. Thai P. Puerto Rican G. Guamanian S. Other Southeast Asian 4. Other Latina/o, Spanish origin, Hispanic

H. Hawaiian 8. Other

7. White N. Samoan 9. No response

Form IV Letters of Recommendation

Note to applicant: You need to submit four letters of recommendation with your application. You may either make four copies of the recommendation form on the next page or include letters of recommendation on letterhead that address the areas described in the recommendation form. (Form is located on next page.)

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Letter of Recommendation for The Single Subject Credential Program at

California State University, Stanislaus

The person named below is an applicant to the Single Subject Credential Program at CSU Stanislaus. The Program prepares prospective teachers to teach in grades 7-12 or as subject matter specialists. Please provide a statement of your judgment of the applicant’s qualifications for the teaching profession. This letter of recommendation by you will be seen by the applicant and will be used by the Selection and Review Committee as part of the criteria for admission to the Program. Thank you for helping us select the best candidates for our program. Applicant’s name: Major Name of evaluator (please print): Business address: phone:

Characteristic Have no information

Top 10% Excellent

Top 25% Good

Top 50% Fair

Bottom 50% Poor

Comment

General attitude

Initiative/enthusiasm

Responsibility

Verbal skills

Writing skills

Academic competence

Rapport with peers

Rapport with supervisors/instructors

Rapport with adolescents

Overall rating

Based on your knowledge of the candidate, why do you think this person will or will not become an effective secondary teacher? Please explain your response.

Please check items that app ly: I have taught candidate I have supervised candidate I know candidate well Evaluator’s signature Date Organization or affiliation Position

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Form V

Subject Matter Preparation

To the Student: Name: Last First You must pass CSET or complete Subject Matter Preparation Program before joining a field site (cohort) or beginning an internship. Please indicate which of the two options you are using to complete Subject Matter Preparation: ______ CSET exam in subject area (if using this option, attach copy of CSET exam results) If you have not yet taken the CSET, attach a copy of your application to indicate you have formally applied to take the CSET. ______ Completion of Subject Matter Preparation Program (if using this option, have your Subject Matter Preparation Program advisor complete the remainder of this form) To the Subject Matter Preparation Program Advisor: Please check the choice that applies to the above-named student 1. ______ Has completed the CSU Stanislaus Subject Matter Preparation Program in

__________________ (subject). 2. Has completed the equivalence of the CSU Stanislaus Subject Matter Preparation Program in __________________ (subject) at another institution (please specify) . (Signature of Credentials Analyst at that institution required.) 3. ______ Has completed 4/5 of the CSU Stanislaus Subject Matter Program in __________________ (subject). Date expected to complete the program . __________________________________________________ __________________ Signature, SMPP advisor Date

Notes:

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Form VI

CBEST Verification

(see page 4 of advising packet for more information) If you have passed CBEST, tape the verification transcript below. If you have taken CBEST, but not passed, tape the score sheet below. If you have not yet taken CBEST, tape a copy of the first page of the CBEST application and a copy of your check to indicate you have formally applied to take the CBEST. YOU MUST PASS CBEST BEFORE JOINING A FIELD SITE OR BEGINNING AN INTERNSHIP.

*************************************************************************************

Form VII

TB Clearance Verification

Tape your results of your TB tests below. TB Clearance is valid for four years.

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Form VIII

Verification of 45 hours of observation

Name: Student ID: (see page 5 of advising packet for more information) Option 1: Coursework that met the 45 hours of observation requirement: (Attach additional verification of course information if needed) Option 2: Observation in schools: Attach letters on school letterhead from administrators or teachers verifying your observation time. The letters need to include the dates, number of hours, and an indication that your participation was satisfactory. Documentation is subject to review by the Coordinator and/or Selection and Review Committee.

SSCP Verification: ________ Approved (please initial) ________ Returned to student for completed verification

Course name and number:

Semester and year taken:

Grade:

Number of hours of observation:

Professor’s signature:

Professor’s printed name:

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Form IX Technology Proficiency

Applicant’s Name Student ID number I verify that the information provided below is accurate and that the submitted materials are my own independent work. Applicant Signature Option 1: Completion of coursework. Any coursework submitted for consideration must be completed with a grade of C/CR or above. Equivalent courses may be transferred from other institutions. If you complete a course other than one of those listed below, you must staple the catalogue description or course syllabus to this form. The description/syllabus must document that the course content and assignments included the use of word processing, email, internet searches, and one additional type of software. Indicate the semester and year of completion on the appropriate line: C S U S t a n i s l a u s c o u r s e s : Community College Courses CIS 2000 MUS 2150 CS 11 SJDC COGS 3100 MUS 2160 CS 18B SJDC CS 1000 PHED 3370 CPSC 30 Merced College CS 2000 PHED 4300 SCS 24 Merced College CS 4000 SSCI 3005 CMPSC 201 MJC Other Course ______CMPSC 203 MJC

Option 2: Document submission

The documentation must include appropriate artifacts as noted below to demonstrate your attainment of each proficiency. Staple the documentation to this form.

Word processor: Attach two different types of documents (essay, report, newsletter, etc.) to demonstrate that you can effectively communicate ideas in a print format. This should include effective use of format features (page numbers, alignment, font and size changes, spell-check, graphics, tables, tabs, etc.)

Email: Include two printed samples that show you know how to successfully send and reply to messages, and that you can send and receive attachments.

Internet: Include one sample, which demonstrates you can effectively find appropriate information from credible internet sources, and that you can cite the source in either APA or MLA format. Write a one-paragraph narrative explaining criteria you would use to determine if sources are valid, and explain how you search for information on the internet.

One additional technology tool: Include a printed sample that demonstrates your capacity to communicate through one additional technology tool such as spreadsheets, databases, presentation software, web page creation programs, or other multimedia programs. Credential applicants: do not write below this line:

Reviewed by: Date: Approved by: Date: The applicant has fulfilled the technology proficiency requirement has NOT fulfilled the technology proficiency requirement

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REQUEST FOR LIVE SCAN SERVICE

Applicant Submission