CREDENTIAL APPLICATION School of Leadership and Education Sciences University of San Diego CONTACT INFORMATION to appear on credential: Full Name last
first
Date of Birth (mm/dd/yyyy)
maiden/former name(s)
Social Security Number USD e-mail
USD ID #
@sandiego.edu
Permanent e-mail CREDENTIAL INFORMATION Indicate which credential(s) applying for: _____Multiple Subject_____BCLAD
_____Single Subject/indicate subject:
_____supplementary or NCLB authorization(s) _____Education Specialist: mild moderate
intern
preliminary
professional
_____moderate severe _____early childhood
Deaf/Hard of Hearing
_____Pupil Personnel Services: school counseling _____Administrative:
Intern
preliminary
professional
REQUIREMENTS SEE HANDBOOK FOR SPECIFIC REQUIREMENTS FOR YOUR CREDENTIAL. Please fill in how requirements for your credential were or will be met and attach DOCUMENTATION (make or order a copy for yourself). Transcripts must be in a sealed envelope. REQUIREMENT WHERE COMPLETED DATE ATTACHED Transfer Transcripts: Bachelor's Degree: U.S. Constitution: CPR infant, child and adult: Eng 318e OR Ed 558XB: Exams (CBEST, CSET, RICA etc.): Credentials/Certificates DEADLINE Submit this packet as soon as possible to the Credential Analyst. You may not receive verification of credential completion if you do not submit this completed packet before the deadline posted by the Credential Analyst. At the end of the semester after the Credential Analyst has received final grades you will receive an e-mail from the California Commission on Teacher Credentialing (CCTC) requesting payment by credit card. Respond to this email in a timely manner so that you may receive verification of your credential. Once the CCTC has completed a professional fitness review you will receive an e-mail verifying you qualify for the credential to print out and show prospective employers. SUBMIT TO: Credential Analyst, SOLES Building Student Services Center Room 101D Mailing address: 5998 Alcala Park San Diego CA 92110-2492 (619) 260-4821 e-mail: Credential@SanDiego.edu I understand the above and authorize USD to release my information including transcripts to the CTC: Date
Student Signature Applicant please do not write below this line
CREDENTIAL APPROVAL By my signature I verify that this student has completed all USD credential program requirements: Credential Analyst
Date
Program Director/Chair
Date