Aug 1, 2016 - required Commission on Teacher Credentialing application documents to: Child Development ... For assistanc
Child Development Permit Application Policies & Instructions For: Licensed Family Child Care Owner – First-time To ensure timely processing of your Child Development Permit Application Packet, please assist us by reading and following all directions carefully. 1. The Child Development Permit Stipend program year runs August 1, 2016 through July 31, 2017. 2. The Child Development Training Consortium (CDTC) will pay requests for the Permit Stipend and Live Scan Fingerprint Processing Fee Reimbursement, if applicable, for the following permits: • • • •
Assistant (First Time and Renewal) Associate Teacher (First Time, Renewal, and upgrade) Teacher (First Time, Renewal, and upgrade) Upgrades from one of the three lower level permits listed above to Master Teacher, Site Supervisor, and Program Director • On-line Renewal of the Teacher Permit only, reimbursement in the amount of $100
3. Funding of a permit application fee is limited to one time each program year. 4. Permit Funding is limited and will be processed on a first-come, first-serve basis with priority given to eligible applicants who are applying for: a) Initial (first-time) permits, starting with the lowest level permits b) Permit renewals, starting with the lowest level permits c) Permit upgrades, starting with the lowest level permits
5. Applicant must work or live in California and qualify for the permit level applying for to be eligible for the CDTC Permit Stipend and Live Scan Reimbursement. 6. DO NOT submit any form of payment with your permit application packet. 7. An incomplete application packet will NOT be processed, it will be returned within 6 weeks, delaying obtainment of a Child Development Permit. 8. Permit applications submitted directly to the Commission on Teacher Credentialing (CTC) are not eligible for reimbursement. 9. Permit extension applications are not eligible and will NOT be processed, it will be returned to the applicant within 6 weeks. 10. Before submitting, make a copy of the entire application packet to keep. 11. Return completed Child Development Permit Application Packet with all
required Commission on Teacher Credentialing application documents to: Child Development Training Consortium P.O. Box 3603 Modesto, CA 95352 For assistance email
[email protected] or call (209) 572-6080 Page 1
Revised 8/1/16
Submittal Checklist: First-time Applicant Licensed Family Child Care Owner Before completing and submitting a permit application packet to the CDTC office, review and confirm permit funding level eligibility; refer to #2 of the Permit Application Policies & Instructions on page 1. • Check each box to the left of the form once it is complete. • Attach this form to the front of your completed Child Development Permit application packet. □
1. CDTC* Child Development Permit Stipend Request Form
• Information must match Application Form 41-4 □ 2. CTC** Application for Credential Authorizing Public School Service Form 41-4 (Rev. 4/2017 or later) • Review for completeness, ALL five pages of the 41-4 form are required. • Section 1: Complete all required fields identified with an asterisk (*). • Section 2: Complete CREDENTIAL TYPE using one of the following options; applying for the first time, permit renewal, permit upgrade. Complete the Child Development Permit level applying for (PK field); if using the Permit Matrix Alternative Qualifications write option 2, 3, or 4 next to the permit level. Select the School-Age Emphasis box, if applicable, otherwise leave blank. • Section 3: If renewing, include PGA hours and advisor information, if not renewing enter NA. • Section 4: Answer ALL professional fitness questions (a-f), and follow the additional instructions for completing an explanation form for any “Yes” answers. • Section 5: Read the statements and check the “I agree” box. • Section 6: Complete the information or enter NA, if not employed by school district. • Section 7: Enter current DATE, CITY, COUNTY (not country), STATE, and SIGNATURE. □ 3. CTC Request for Live Scan Service Form 41-LS (Rev. 4/2015 or later) or Dual Live Scan Submission □ 4. Original transcripts or copies of transcripts signed off by county office of education or VOC • CDTC will not accept eTranscripts, unless they are submitted by the county office of education □ 5. Licensed Family Child Care Experience – Must be verified by a photo copy of the Family Day Care State License as well as completing Form CL-878 (in English/Spanish) Child Development Permit Verification of Family Child Care Experience. Three different parents must complete Form CL-877 (in English/Spanish) Child Development Permit Verification of Family Child Care Attendance. If applying for Site Supervisor or Program Director a personal letter documenting job duties must be included. Example, of duties should include supervising a helper, managing the subsidized food program, budgets and any helpful details of running the family child care business. If applying under alternative qualifications, or for an Assistant Permit, verification of experience is not required. □ 6. CDTC Live Scan Fingerprint Processing Fee Reimbursement Request Form, with original receipt □ 7. Confidential Profile for Direct Service Participants Form (PD Profile) □ 8. Before submitting, make a copy of the entire application packet to keep
Return completed Child Development Permit Application Packet with all required Commission on Teacher Credentialing application documents to: Child Development Training Consortium P.O. Box 3603 Modesto, CA 95352 Do not include any form of payment with your application. Incomplete application packets will not be processed and returned to the applicant.
For assistance email
[email protected] or call (209) 572-6080 *CDTC: Child Development Training Consortium Page 2
**CTC: Commission on Teacher Credentialing Revised 8/1/16
For Child Development Consortium Staff Use Only PD Profile: � Hard Copy Live Scan: � Yes � No
Type of Permit: � 1st Time � Renewal Date Received:
� Needed
Fees Paid: � Upgrade � Online Renewal File Date:
Child Development Permit Stipend Request Form Complete every question, sign, and date verification statement (#18). DO NOT USE ABBREVIATIONS. 2) First Name:
1) Last Name:
3) Last Five Digits of Social Security Number: ___ - ___ ___ ___ ___
4) Birthdate (mm/dd/yyyy):
5) Mailing Address:
6) City: 8) Zip code:
7) State: 10) Contact Phone Number: (
9) County:
)
11) Email Address: 12) Permit Stipend Type Applying For, select one: □ First Time Permit □ Renewal of Current Permit
□ Upgrading to Higher Level Permit
□ Online Renewal
13) Permit Level Applying For, select one: □ Assistant □ Associate Teacher □ Teacher (1st Time, Renewal, Upgrade) □ Master Teacher □ Site Supervisor □ Program Director (Only if upgrading from one of the 3 lower level permits) 14) School-Age Emphasis: □ No 15) Gender: □
Female
□
□ Yes Male
16) Race/Ethnicity: □ Asian □ African-American/Black □ Multi-racial □ Pacific Islander 17) Currently Attending College: □ No
□ Alaskan/ Native American □ Other (specify):
□ Hispanic/Latino □ White/Caucasian
□ Yes, Name of College:
18) I verify that all required documents are complete and attached. I understand an incomplete permit application packet will be returned to me unprocessed and will delay receipt of the permit for which I am applying. I certify that my information may be shared with the stipend provider; California Department of Education - Early Education and Support Division, and/or their research partners for the purpose of evaluating this project. Applicant’s Signature:
Date:
Return completed Permit Stipend Request Form with all required Commission on Teacher Credentialing permit application documents to: Child Development Training Consortium P.O. Box 3603 Modesto, CA 95352 Do not include any form of payment with your application. Incomplete application packets will not be processed and returned to the applicant. For assistance email
[email protected] or call (209) 572-6080 Page 3
Revised 8/1/16
APPLICATION FOR CREDENTIAL AUTHORIZING PUBLIC SCHOOL SERVICE (For Privacy Act Notification see Application Instructions)
Mail application and payment (check or money order) to: Commission on Teacher Credentialing Certification Division 1900 Capitol Avenue Sacramento, California 95811-4213 APP
Appeal:__________________ Route to: ________________
IHE/County/District Use Only
Commission Use Only: Fee Information FP Other
Issuance Date:____________________________ Email Address:_________________________
CTC Use Only
1. PERSONAL INFORMATION (type or print) *Social Security or Individual Tax ID Number:
*Date of Birth: (mm/dd/yyyy)
*Applicant’s Full Legal Name: First
Middle
Last
IHE/County/District Use County or District of Employ (CAOnly only):
Former/Maiden Name(s): *Address: *City:
*State:
Home Phone:
Work Phone:
*Email Address:
2. CREDENTIAL TYPE
*Zip: Issuance Message Phone: Date:__________________ E-Mail Address: ________________
CCTC Use Only (choose only one type below)
OPTIONS:
Substitute Permits (PT)
English Learner Authorizations
Single Subject (Secondary Teaching)
BILINGUAL AUTHORIZATION – Specify Language
Specify Subject (If you are requesting more than one subject, enter it in
Services Credentials
Comments box.)
Specify World Language other than English (if applicable)
Term Specify Other Health Services
Term
Child Development Permits (PK) Multiple Subject (Elementary Teaching)
School-Age Emphasis
Term
Designated Subjects (PW)
Education Specialist (Special Education)
Subject(s)
Term
(If you are requesting more than one specialty area, enter it in Comments.)
Supplementary Authorization(s) (PJ)
Specify Specialty Area
Subject Matter Authorization(s) (PJ) Other Specialist Credentials
Term CTC Use Only
Added Authorizations (AASE)
FORM 41-4 (REV. 4/2017)
* = Required Fields
1
3. CHILD DEVELOPMENT PERMIT RENEWAL SELF-VERIFICATION (CURRENT CHILD DEVELOPMENT PERMIT HOLDERS) As the holder of a Child Development Permit (any level except the Associate Teacher Permit) you must complete a specific number of planned and approved professional growth activities for each five-year renewal. These activities must be recorded on the Professional Growth Plan and Record form. As the holder of a Child Development Permit choosing to self-verify completion of these requirements, you may be subject to an audit. The Commission reserves the right to request submission of these forms for auditing purposes any time within one year following submission of this application. If the Commission determines through its audit that you did not complete the professional growth requirements, your permit will not be renewed and you may be subject to adverse action on other credentials you currently hold. You must retain your Professional Growth Plan and Record form for one year following the submission of this application.
DECLARATION: I certify (or declare) that I have read the above and completed the following for this renewal of my clear credential: I have completed __________ hours of professional growth activities My Professional Growth Advisor is ___________________________________________ Advisor’s Name
____________________________ Advisor’s Phone Number
4. PROFESSIONAL FITNESS QUESTIONS Answers to the following questions are required. If you answer yes to any question, you must complete the corresponding Professional Fitness Explanation Form. Before granting your application, the Commission will review, at a minimum:
Federal Bureau of Investigation criminal history (rap sheet) California Department of Justice criminal history (rap sheet) International database of teacher misconduct maintained by the National Association of State Directors of Teacher Education and Certification (NASDTEC) Previous reviews by the Commission Complaints from others Notifications from school districts Teacher preparation test score violations
You must disclose misconduct, even if:
It happened a long time ago It happened in another state, federal court, military or jurisdiction outside the United States You did not go to court and your attorney went for you You did not go to jail or the sentence was only a fine or probation You received a certificate of rehabilitation Your conviction was later dismissed (even if under Penal Code section 1203.4), expunged, set aside or the sentence was suspended
Warning:
