North Coast Teacher Induction Program CTE Preliminary ... · document. By signing this document you...

NCSOE - CTE Preliminary Credential Checklist Revised 2016-17

NorthCoastTeacherInductionProgram 5340SkylaneBlvd,SantaRosaCA,95403

Phone:707-524-2818Fax:707-524-2815Website:www.ncsoe.org

CTEPreliminaryCredentialApplicationChecklistBasedonSB1104–IssuedonorafterJanuary1,2009

ToberecommendedforapreliminarycredentialbytheNorthCoastTeacherInductionProgram,youmusthaveacceptedanemploymentoffercorrespondingtothecredentialrequested..Pleaselistyouremployingdistrict/agencyandschool/worksite.ProgramServicesFeemayapply.SeeFee-for-Serviceflyerorcontacttheregionalofficeforinformation.

CredentialCandidate:________________________________________________County:________________________

District/Agency:__________________________School/WorkSite:_____________________HireDate:___________

CredentialAnalyst:_________________________________ContactNumber:_________________________________

ToapplyforaPreliminaryCTEDesignatedSubjectscredential,submitthefollowingitemstoyourcountyofficeofeducationcredentialanalyst.Incompleteapplicationsmaybereturnedorheldforfurtherprocessing.Yourcountyofficeanalystwillreviewyourapplication,contactyouforadditionalinformationasneededand,onceyouareemployed,willforwardthecompletepackettotheNCTIPforsubmissiontotheCaliforniaCommissiononTeacherCredentialing(CCTC).DonotmailtheapplicationdirectlytoCCTC.Thismayresultinadditionalfeesandprocessingtime.

PLEASEINCLUDETHISCOMPLETEDCHECKLISTWITHYOURAPPLICATIONPACKET

¨ 1.VerificationofEmploymentForm:Besuretheformisfullycompletedandsignaturesecured.

¨ 2.WorkExperience:Threeyearsofworkexperiencedirectlyrelatedtoeachindustrysectortobenamedonthecredential.Oneyearequalsaminimumof1000clockhoursandtheexperiencemaybefull-timeorpart-time,paidorunpaid.ProvideaccountingofparttimehoursusingtheDesignatedSubjectsCredentialWorksheetifneeded.SeeTermsandDefinitionsofCL-888foradditionalinformationregardingtheworkexperiencerequirement.

¨ 3.HighSchooldiplomarequirement:OfficialTranscriptsrequired(openedoriginalsarefine).

¨ HighSchooldiploma,AA,BA,orhigher ¨ Theforeignequivalentofahighschooldiploma¨ DiplomabasedonpassageoftheGEDTest ¨ CurrentCACredential–Provideaprintedcopy

¨ 4.ProgramAdvisement&CredentialAuthorizationSelectionForm:Pleaserefertopages5-12oftheCTCCL-888leafletfor

detailedindustrysectorbreakdowns.Yourchoiceshouldmatchexactlywhathasbeenindicatedinsection2onyour41-4document.BysigningthisdocumentyouacknowledgeyouhavebeenadvisedofNCTIPprogramrequirementsforthispreliminarycredentialandsubsequentclearcredential.(SeeNCTIPClearCred.ApplicationChecklistinadditiontoCL-888.)

¨ 5.ApplicationforCredentialAuthorizingPublicSchoolService(CTCform41-4):Completesections1-7.PleasereadcarefullytheInstructionandInformationSheet(Form41-4)forfurtherdirectionsoncompletionofyourapplication.Theapplicantmustinitialanychangesoradditions.

¨ 6.Fingerprints:RequiredunlessyoualreadyholdavalidcredentialorCertificateofClearance(providecopy)fromtheCommissiononTeacherCredentialing(CTC).SubmitacopyofthecompletedRequestforLiveScanServiceForm(41-LS)uponcompletionbytheLiveScanoperator.(Feesforfingerprintingvaryandarecollecteddirectlyfromtheprocessingagency.)Current/ValidCAteachingcredential,provideaprintedcopyfromtheCTCwebsite.

¨ 7.$100.00MoneyOrderorCashier’sCheckpayabletotheCaliforniaCommissiononTeacherCredentialingorCTC.IfNCTIPisnotabletorecommendyoutoCTCforthecredential,thisfeewillbereturnedtoyou.IfyouhavequestionspleasecontactSherryNavarro,[email protected].

ForNCTIPuseonly:Datecompletedpacketreceived:_________________________CredentialIssuanceDate:_________________________________

Allrequireddocumentsattached&verifiedby:_________________________________________________Date:_______________

Recommendationapproved:________________________________________________________________Date:_______________

RecommendationsubmittedtoCTCby:________________________________________________DateProcessed:______________

NCSOE - DS Verification of Employment – Revised 2016-17

NorthCoastTeacherInductionProgram

5340SkylaneBlvd,SantaRosaCA,95403Phone:707-524-2818Fax:707-524-2815Website:www.ncsoe.org

Verification of Teaching Employment Form

for Designated Subjects Credential Candidates

(Adult Ed/CTE/Special Subjects/Supervision & Coordination) To Employing District/Agency: The recommendations for Preliminary Designated Subjects Credentials are submitted by the CTC approved program for our region, The North Coast Teacher Induction Program (NCTIP). In order to recommend a candidate for a designated subjects credential, NCTIP requires employment on the requested credential. Please verify your employment offer for the holder of this form.

_________________________________________________________ has been offered a contracted teaching position

as the teacher of record in the subject area of _____________________________________ requiring a

Career Technical Education or Adult Education credential. (Please circle one)

Official Hire Date: ___________________ District/Agency: ____________________________ School/Work site: ________________________ Employer Authorized Signatory: ___________________________________________________________ Please print

Title: ________________________________________ Phone Number: ___________________________ Authorized Signature: __________________________________________ Date: ____________________ This Verification of Teaching Employment form is to be included with the candidate’s application. The application packet is submitted to the NCTIP for final review and credential recommendation to the CTC. The final authority to grant or deny a credential rests with the CTC. Once recommended to CTC, candidates must enroll and participate in the North Coast Teacher Induction Program to meet their credential program requirements. A Credential Advisement will be provided by program staff and program fees will apply. For current program fees, refer to the Fee-for-Service flyer posted on the website: www.ncsoe.org. NOTE: Teachers being employed on a short-term basis are not eligible for the NCTIP Designated Subjects credential program. Instead, please use CL-786 for Emergency Designated Subjects CTE 30-day Sub Permit or the Business and Industry Partnership Teacher (BIPT) Credential. For additional information regarding completion of this form, contact your local County Office of Education Credential Analyst.

NCSOE-CTEWorkVerificationGuidelines-Revised2016-17

NorthCoastTeacherInductionProgram5340SkylaneBlvd,SantaRosaCA,95403


Designated Subjects Career Technical Education Credential (CTE) Work Experience Verification Guidelines

To verify the minimum three (3) years of required industry work experience in the subject(s) to be named on the credential you will need a letter(s) from your present or previous employer(s). The letter(s) should be original, on company letterhead and contain the following information:

§ Addressee: Commission on Teacher Credentialing (CTC)

§ Current date

§ Employer’s name, address, and telephone number

§ The name of the credential applicant

§ The working relationship of the person signing the verification to the applicant

§ Beginning and ending dates (month, day, and year) of employment with the employer

§ Job title and complete description of duties

§ A statement as to whether the employment was full-time or part-time. If employment was less than full-time, an accounting of the number of hours the applicant was employed is required (1000 hours is equivalent to one (1) year).

Work Experience requirements: At least one (1) year of the required work experience must be within the past five (5) years, or two (2) years within the last ten (10) years, immediately preceding the issuance of the preliminary credential. Please Note:

1. Teaching may be used as qualifying experience, in addition to actual Industry work experience, for the CTE Credential. Teaching experience may also be used to meet the recency requirement which states that you must show you have worked one year, or 1000 hours during the last three years in the area of the subject/s to be named on the credential.

2. Completion of forty-eight (48) semester units of

postsecondary vocational training related to the industry sector(s) named on the credential may be substituted for a maximum of two of the three years of required work

NCSOE-CTEWorkVerificationGuidelines-Revised2016-17

experience. The coursework must be verified by official transcript and may be used on a pro rate basis up to the two (2) year maximum.

3. You may use a combination of teaching and units, as long as there is one year of actual Industry work

experience. Self-Employment Verification: The following are required to verify self-employment:

1. An employment letter written by you on company letterhead that includes the seven items listed above for Work Experience Verification. The letter must be signed and must contain the following statement: “I certify under penalty of perjury that the aforementioned information is true and correct to the best of my knowledge.”

2. Copies of documents verifying the business such as a business license, professional licenses or certifications, Tax ID number, articles of incorporation, etc.

3. Letters (preferably 2) from other people having first-hand knowledge of your work, such as your business’ accountant, major supplier of goods, or major user of goods or services. These letters should be written on the letterhead of the writer, unless from an individual customer, and should contain the following information:

§ Addressee: Commission on Teacher Credentialing (CTC)

§ Current date

§ The writer’s name, address, and telephone number

§ The name of the credential applicant and the name of their business

§ Description of the writer’s professional association with the applicant

§ Beginning and ending dates (month, day, and year) of business relationship with the applicant

§ Description of the writer’s knowledge of work performed or services provided by the applicant

NCSOE–DSExperienceWorksheet–Revised2016-17

NorthCoastTeacherInductionProgram

Designated Subjects Credential Worksheet Career Technical Education (CTE), Adult Education (AE)

Use this worksheet to document the required Work Experience Requirement for each industry sector to be named on the credential. Enter only the items you are requesting to be used towards the minimum required work experience. Items listed here will correspond with verification provided. CTE/Adult Ed: “Three years of work experience directly related to each industry sector to be named on the credential.” Important: A combination of the items listed below may be used to meet the three years work experience, but at least one year (1,000 hours) must be actual industry work experience. First Name: Last Name: Credential: ¨ CTE ¨ Adult Ed WORK EXPERIENCE: (list by year) Employer Start Date End Date Hours Notes EDUCATION: “A combination of forty-eight (48) semester units of postsecondary vocation training related to the industry sector named on the credential may be used to substitute for a maximum of two of the three years of required work experience.” Name of College – University - Trade School Degree or Certificate

Received Units Notes

VOLUNTEER EXPERIENCE: (list by year) Organization or Activity Start Date End Date Hours Notes

NCSOE–DSExperienceWorksheet–Revised2016-17

Other Credential(s) Held: “One year of full-time general education teaching experience providing instructional services in preschool or grades K-12 earned in a public or private school of equivalent status.” Credential Type State Credential

Earned Year(s) Teaching

Notes

TOTAL HOURS Category Total Hours Total Units Recency Notes Work Experience Education Units Volunteer Experience Teaching Experience

GRAND TOTAL

NCSOE - CTE Work Experience Verification Guidelines – Revised 2016-17

NorthCoastTeacherInductionProgram5340SkylaneBlvd,SantaRosaCA,95403


CTE Work Experience Verification Guidelines

When selecting an Employment Verification Template, choose the one that works best for your industry experience situation. Multiple forms of verification may be used. Templates include:

1) Employer Verification: to be used if you are able to make contact with the necessary personnel related to the employment where you earned industry experience in the subject area requested on your credential. Must be on Company Letterhead.

2) Employer Verification is not available: to be used if you attempted to contact the necessary

personnel related to the employment where you earned industry experience in the subject area requested on your credential, but your attempts were unsuccessful. It is important that you sign the affidavit under penalty of perjury at the bottom of the letter; your application will be returned without this signature and statement.

3) Self-Employed Verification: to be used if you earned your industry experience in the subject

area requested on your credential through self-employment. Please provide a minimum of 2 supporting documents as noted on page 3 of the CTC leaflet, CL-888, Designated Subjects Career Technical Education Teaching Credential. It is important that you sign the affidavit under penalty of perjury at the bottom of the letter; your application will be returned without this signature and statement.

4) Combination of templates: to be used as needed if your industry experience situation is a

combination of any of the above.

5) Use the Experience Requirement Worksheet to document the three years of experience related to the industry on the credential. If applying for more than one industry certification, experience must be documented in all areas.

Employer verification of employment/work experience

~~~ WHEN AVAILABLE, THIS FORM SHOULD BE COPIED ON COMPANY LETTERHEAD ~~~ (If not available, please add company name, address, and phone numbers to top of sheet)

Date: To: Commission on Teacher Credentialing

Via the North Coast Teacher Induction Program Dear Certification Officer: This letter is to verify employment for . (name)

Dates Employed: (begin date) (end date)

Employed: Full-time Part-time (REQUIRED: Specify total number of hours worked: ) Job Duties: Check if job description is attached

(Attach additional sheets if necessary) This employment information is verified by: Print Name

Title Signature

Employment/work experience verification


Via the North Coast Teacher Induction Program Dear Certification Officer: This letter is to verify employment for . (name)

I have made a sincere effort to contact my previous employer. Some examples of how I’ve tried to make contact include: Since I am unable to obtain employer verification, I provide the following information as actual facts regarding my employment at the named organization. Employer Name:

Address:

City, State Zip:

Phone number:

Dates Employed: (begin date) (end date)

Employed: Full-time Part-time (REQUIRED: Specify total number of hours worked: ) Job Duties: Check if job description is attached

(Attach additional sheets if necessary)

I CERTIFY UNDER PENALTY OF PERJURY THAT THE AFOREMENTIONED EMPLOYMENT / EXPERIENCE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. Signature Date

Self-employment verification


Via the North Coast Teacher Induction Program Dear Certification Officer: This letter is to verify self employment for . (name)

I am providing the following information as actual facts regarding my self employment related to the requested credential. Business Name:

Address:

City, State Zip:

Phone number:

Dates Employed: (begin date) (end date) Employed: Full-time Part-time (REQUIRED: Specify number of total hours worked ) Job Duties: Check if job description is attached (You may find a paragraph format detailing your self-employment history more applicable. Include hours worked per year and job duty detail which each time period noted.)

(Attach additional sheets if necessary)

I CERTIFY UNDER PENALTY OF PERJURY THAT THE AFOREMENTIONED EMPLOYMENT / EXPERIENCE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. Signature Date

NCSOE – CTE Program & Credential Advisement – Revised 2016-‐17

North Coast Teacher Induction Program 5340 Skylane Blvd, Santa Rosa CA, 95403

Phone: 707-‐524-‐2818 Fax: 707-‐524-‐2815 Website: www.ncsoe.org

CTE Program Advisement & Credential Authorization Selection Form

Place a check in the box next to the subject authorization for which you are applying. For further breakdown regarding the industry sectors listed, please refer to CTC CL-888 leaflet. Career Technical Education (CTE) Allows CTE instruction in the following career fields for grades twelve and below and in classes organized primarily for adults: q Agriculture and Natural Resources q Arts, Media, and Entertainment q Building & Construction Trades q Business & Finance q Education, Child Development, & Family Services q Energy, Environment and Utilities q Engineering and Architecture q Fashion and Interior Design

q Health Science and Medical Technology q Hospitality, Tourism, and Recreation q Information & Communication Technology q Manufacturing and Product Development q Marketing, Sales, and Service q Public Service q Transportation

Participation in a CTC approved program is required to clear these credentials. Before signing below, please read carefully the CTC CL-888 leaflet which details both the Preliminary and Clear Career Technical Education Credential requirements. Upon finalization of your application by the North Coast Teacher Induction Program, you will receive further advisement regarding your personalized program. I understand and acknowledge that I must participate in the CTC approved personalized program in order to receive the recommendation by the North Coast Teacher Induction Program. This includes completing the Foundations & Orientation Course (or pre-approved equivalent) within 30 days of my hire date. I also understand that in order to receive a recommendation for a clear credential I must fulfill all program and credential requirements. I plan to enroll in the appropriate program and understand I will receive additional advisement by the North Coast Teacher Induction Program based on my specific credential. Applicant Name (please print) Applicant Signature Date

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41-4 INSTRUCTIONS 4/2016

APPLICATION FOR CREDENTIAL AUTHORIZING PUBLIC SCHOOL SERVICE (Form 41-4)

Instruction and Information Sheet

__________________________________________________________________________________________

This application form may be used to apply for or renew any credential, certificate, or permit type with the

exception of variable term waivers. A separate application form and fee is required for each credential for

which you apply. You must use the current version of application Form 41-4. It is available for download

from the Commission’s website at http://www.ctc.ca.gov/credentials/leaflets/414.pdf. APPLICATION FORM Type or print all information requested on the application form. Applications not completely and accurately filled

in and accompanied by all required supporting materials will be returned to the applicant. It is advisable after

filling out the application online to print an extra copy to keep with your records until your credential is issued.

You must provide the Commission with a valid email address on your application form to receive the automated

emails that will notify you of your application and credential status.

If you are employed on an emergency permit (other than a 30-Day or Prospective Substitute Permit), Limited

Assignment Permit, Short-Term Staff Permit, Provisional Internship Permit, or one-year nonrenewable credential,

you must apply through your employing agency.

If you are completing a professional preparation program through a Commission-approved program sponsor, the

program sponsor will initiate the application process by submitting the application to the Commission

electronically on your behalf. If you are not currently completing your professional preparation program or

employed in the public schools of California, you may send your application directly to the Commission.

Supporting Documentation

Each time you submit a new application, you are responsible for providing appropriate official transcripts, letters

verifying experience, examination score reports, and other information needed to determine your eligibility for

the current issuance of the credential. Transcripts or other supporting materials sent separately from the

submission of an application and payment or from a Commission letter requesting the documentation are

destroyed without being reviewed. The Commission does not maintain pending files and cannot match pieces

of an application that arrive separately.

Supporting documentation, including transcripts, will not be returned. The Commission does not maintain a file

of all supporting materials sent with every application. Educators should retain a copy of each application and the

related supporting materials submitted to the Commission for reference. Requirements may be subject to change

and are fully referenced in California Code of Regulations, Title 5, and the California Education Code.

Unless otherwise specified, the term "credential" as used herein means any type of credential, certificate, or permit

issued by the Commission.

FEES Please refer to the Commission’s fee schedule (Credential Leaflet CL-659) to determine the amount due. You

may pay by check or money order, made payable to the Commission on Teacher Credentialing or CTC. Do not

send cash. A service charge of $20 will be assessed for a check that does not clear the bank and your

credential may be voided until all fees due are paid in full. If you are applying through a county office of

education or school district office, you may be asked to make the check payable to that agency so that they can

submit a single check to the Commission for all of their applicants. Applications submitted without the

appropriate payment will not be processed and will be returned.

http://www.ctc.ca.gov/credentials/leaflets/414.pdf


http://www.ctc.ca.gov/credentials/leaflets/cl659.pdf

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Following the submission of the application, fee, and supporting materials, the application will be evaluated to

verify eligibility for the document requested. If you receive a letter requesting additional information to complete

your application (it may or may not be accompanied by your original application), you must attach the requested

documentation to the Commission’s letter and resubmit all items within 60 days of the date on the letter you

received or a new application fee is required. If your application was also returned for correction, you must return

the original application with the corrections required included. Do not replace it with a new application form.

Your application and fee remain valid for sixty (60) days (Reference: Title 5, California Code of Regulations,

section 80487). Application fees are earned upon receipt and are not refundable. If you do not qualify for the

credential type originally applied for, the fee cannot be used to apply for another credential type. If requirements

for a document are met after the initial submission of an application, a new application and fee will be required.

PERSONAL INFORMATION You must complete all the required fields (*) in the Personal Information section, including your full legal name

and list all former names, including your maiden name, if applicable. Additionally, you are required to provide

your full Social Security Number (SSN) or Individual Tax Identification Number (ITIN) on your application

pursuant to 42 USC §666 and California Family Code §17520. If this information is not furnished, your

application will be returned to you for completion. See Coded Correspondence 13-14 on the Commission’s

website for more information.

You are required to notify the Commission of any address change pursuant to 5 CCR §80412. Address changes

may be completed online using the Educator Login button on the Commission’s website.

Privacy The California Information Practices Act and the Federal Privacy Act provide that agencies requesting

information indicate the principal purposes for which that information is used. Your name, former names, SSN,

date of birth, address, email address, and telephone numbers are used to provide proper identification of your file

and, if necessary, to contact you. Other information is used to determine your eligibility.

Information displayed online regarding the documents you hold or have held is public information and may be

disclosed. In addition, pursuant to Education Code section 44230 the Commission may disclose to the agency that

submitted the application all information provided with applications submitted by you through that agency.

Information may also be disclosed to other State or Federal agencies as authorized by law. Personal information

may be disclosed to the public only with your permission or in accordance with the law. The information is

necessary for the Commission to perform its duty under Education Code sections 44200-44439.

You have a right to review personal information maintained on you by the Commission unless access is exempted

by law. The Director of the Certification Division, 1900 Capitol Avenue, Sacramento, California 95811-4213, is

responsible for the maintenance of this information.

TYPE OF CREDENTIAL Use the drop down box next to OPTIONS to select the option appropriate to the purpose of the application. If an

appropriate option is not listed, you can type in that space your reason for submitting the application. Select the

type of credential you are applying for by using the drop-down selections below the heading. A separate

application form and fee is required for each type of credential for which you apply.

If applicable, include the term, subject(s) or specialty areas, and supplementary or subject matter authorizations

that may apply. If you do not find a box appropriate to the credential type you are requesting, you may write or

type your request in using the Comments section on page 5 of the application form. This space can also be used

when seeking more than one subject area on a Single Subject Credential.

http://www.ctc.ca.gov/notices/coded/2013/1314.pdf

http://www.ctc.ca.gov/credentials/default.html

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Note: Abbreviations found on the application form following the title of credentials such as (PT) for Substitute

Permit or (P6) for Administrative Services are for internal Commission use only.

RENEWALS: All clear credentials and Emergency 30-Day Substitute Permits must be renewed online.

The processing time for credentials renewed online is approximately 10 working days.

CHILD DEVELOPMENT PERMIT RENEWAL: SELF-VERIFICATION If you are renewing a Child Development Permit (except the Associate Teacher Permit), you may either complete

the self-verification section on the application form or submit the Professional Growth Plan and Record Form

CL-826 along with your application. If you choose to self-verify the completion of your professional growth

activities, you may be subject to an audit. If the audit determines that you did not complete the professional growth

requirements, your credential 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 your application.

PROFESSIONAL FITNESS QUESTIONS You are required to answer all Professional Fitness Questions. Before granting your application, the Commission

will review your criminal history, if any, from the Federal Bureau of Investigation and California Department of

Justice, a national database of teacher misconduct, previous reviews by the Commission, complaints from those

with first-hand knowledge of misconduct, notifications from school districts, and 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

In accordance with Health & Safety Code sections 11361.5 and 11361.7, you may omit misdemeanor marijuana-

related convictions that occurred more than two years prior to this application, except convictions involving

concentrated cannabis, which must be disclosed regardless of the date of such a conviction.

Warning: Failure to disclose any information requested is falsification of your application and the

Commission may reject or deny your application or take disciplinary action against your credential. If you answer

“yes” to a question, you must complete a Professional Fitness Explanation Form and provide all requested

documentation. If any of the records have been purged or are otherwise not available, provide an original

statement from the agency on its official letterhead verifying that fact.

CHILD ABUSE AND NEGLECT MANDATED REPORTING

Pursuant to Education Code section 44252, you must read this section and check the box “I agree” verifying that

you understand your duties under the Child Neglect and Abuse Reporting Act (Penal Code §11164). Applications

received by the Commission after January 1, 2015 must include the mandatory reporter acknowledgement or they

will be returned to the sender for completion of this information.



http://www.ctc.ca.gov/credentials/online-services/pdf/OA-EF.pdf

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EMPLOYING AGENCY INFORMATION This section must be completed by the employing school agency for applications requesting any credential,

certificate, and permit type where service will be restricted to that employing agency. Individuals applying

directly to the Commission for a document do not need to complete this section.

OATH AND AFFIDAVIT Complete this section and certify (or declare) under penalty of perjury under the laws of California that all the

foregoing statements in this application are true and correct by signing the oath.

FINGERPRINT INFORMATION

California Residents

If this is your first application for a credential, certificate, or permit, you will need to submit verification that you

have had your fingerprints taken electronically by submitting a Live Scan receipt with your application packet.

California residents do not have the option of submitting fingerprint cards. A copy of the Live Scan form may be

found on the Commission’s website at http://www.ctc.ca.gov/credentials/leaflets/41-LS.pdf.

Three copies of the form will be needed for the Live Scan operator. A current listing of Live Scan sites offering

electronic fingerprint services is available to the public on the California Attorney General’s website using this

link: http://ag.ca.gov/fingerprints/publications/contact.php.

If you are renewing a document that has lapsed and have not held any valid document for more than 18 months,

under current regulations you must repeat the fingerprinting process for the Commission before your document

can be reissued. Please see Credential Leaflet CL-271 for more information on fingerprinting.

Out-of-State/Out-of-Country Residents

If this is your first application for a credential and you reside outside of California, you must submit with your

application packet two fingerprint cards (FD-258) and the additional fingerprint processing fees. The California

Department of Justice (DOJ) will accept fingerprint cards only for educators who reside outside of California.

Individuals residing outside of California and applying for employment or licensure in California who cannot be

fingerprinted in California must have their fingerprints rolled at a law enforcement agency in their state or country

of residence. Processing of fingerprint cards takes approximately one month after receipt by the Commission.

Fingerprint cards can be ordered from the Commission by sending an email to [email protected].

ISSUANCE DATES The issuance date of a credential, certificate, or permit is based upon either the initial date of service as determined

by the employer, the completion date of a program as determined by the recommending institution or agency, or

the date the Commission received the application.

Applications Submitted by Agencies

Pursuant to California Code of Regulations Title 5 section 80440 (b) and (c), applications submitted through an

employing agency or recommending institution must be received by the Commission within three months from

the requested issuance date of the credential.

The Commission will honor the issuance date established by the employing or recommending agency or

institution of higher education as long as the applicant is eligible for the document on the date indicated and the

application was received within the submission deadline. If the application is received after the three-month

deadline, the date of issuance of the credential, certificate or permit will be the date the application was received

by the Commission.

http://www.ctc.ca.gov/credentials/leaflets/41-LS.pdf

http://ag.ca.gov/fingerprints/publications/contact.php



mailto:[email protected]

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Applications Submitted by Individuals If an application for a first time or new type of document is submitted directly to the Commission by an individual,

the issuance date of the credential, certificate or permit will be the date the application was received by the

Commission.

If an application for renewal of a document is received on or before the expiration date of the document being

renewed, the Commission will use the expiration date of the old document as the issuance date for the new

document. Applications for renewal may be submitted within one year of a document’s current expiration date.

If an application for renewal is received after the expiration date of the document being renewed, the issuance

date on the new document will be the date the application was received by the Commission.

PROCESSING TIME Applications are processed in the order in which they are received. Commission staff cannot search for pending

applications or process applications out of order. You may check your application status online using the

Educator Login to find the date it was received by the Commission. Click here for the current processing date.

Current law sets a maximum processing time for the evaluation of applications of 50 business days after the

Commission receives a completed application. Applications delayed by a Professional Practices review or

fingerprint processing are not subject to the 50-day restriction. Please wait until the maximum processing time

has passed before contacting the Commission regarding your application status.

ONLINE CREDENTIAL VIEW AND PRINT PROCESS The Commission does not print or mail documents. The official record of credentials, certificates, and permits is

available through an online view to colleges, universities, and employers through the Search for an Educator

option on the Commission’s Home page. Document holders may locate their file using the Educator Login

function on the Commission’s website. Documents are available for view within 3-5 business days of issuance.

For directions on obtaining an unofficial copy of your document, you may use the link View/Print Document for

assistance.

Before you seal the envelope: Be sure you have included the items listed below, all professional fitness questions are answered and that the oath

and affidavit has been signed and dated. Incomplete applications will be returned to the applicant.

□ Completed application (you must use the current version of Form 41-4 available online at

http://www.ctc.ca.gov/credentials/leaflets/414.pdf)

□ Exam score reports, when applicable

□ Official transcripts and other supporting materials, including Professional Fitness Explanation Form,

as applicable

□ Full payment (see Fee Information leaflet CL-659)

First-time California credential applicants must also include:

□ Live Scan receipt (form 41-LS) or for out-of-state/country residents only, two completed fingerprint

cards (FD-258)

Mail the completed application and payment to: Commission on Teacher Credentialing

Certification Division

1900 Capitol Avenue

Sacramento, CA 95811-4213



http://www.ctc.ca.gov/default.html


http://www.ctc.ca.gov/credentials/print-doc.html






FORM 41-4 (REV. 3/2016) 1

APPLICATION FOR CREDENTIAL AUTHORIZING PUBLIC SCHOOL SERVICE (For Privacy Act Notification see Application Instructions)

1. PERSONAL INFORMATION (type or print)

*Social Security or Individual Tax ID Number: *Date of Birth: (mm/dd/yyyy)

*Applicant’s Name:

First Middle Last

Former/Maiden Name(s): County or District of Employ (CA only):

*Address:

*City: *State: *Zip:

Home Phone: Work Phone: Message Phone:

*Email Address:

2. CREDENTIAL TYPE (choose only one type below) OPTIONS:

Substitute Permits (PT) English Learner Authorizations

BILINGUAL AUTHORIZATION – Specify LanguageSingle Subject (Secondary Teaching)

Specify Subject (If you are requesting more than one subject, enter it in Comments box.)

Specify World Language other than English (if applicable)

Term

Services Credentials

Term

Specify Other Health Services

Child Development Permits (PK)

Multiple Subject (Elementary Teaching)

Term

School-Age Emphasis

Designated Subjects (PW)

Subject(s) Term

Supplementary Authorization(s) (PJ)

Subject Matter Authorization(s) (PJ)

CTC Use Only

Education Specialist (Special Education) (If you are requesting more than one specialty area, enter it in Comments.)

Specify Specialty Area

Term Other Specialist Credentials

Added Authorizations (AASE)

CTC Use Only

IHE/County/District Use Only

Issuance Date:____________________________

Email

Address:_________________________

CCTC Use Only

IHE/County/District Use

Only

Issuance

Date:__________________

E-Mail Address:

________________

Mail application and payment (check or money order) to: Commission on Teacher Credentialing Certification Division 1900 Capitol Avenue Sacramento, California 95811-4213

Appeal:__________________

Route to: ________________

Commission Use Only: Fee Information

APP FP Other

* = Required Fields

http://www.ctc.ca.gov/credentials/leaflets/414-instructions.pdf

FORM 41-4 (REV. 3/2016) 2

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 ofTeacher 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 thesentence was suspended

Warning: You will be required to sign your application under penalty of perjury; by doing so you are also stating:

Failure to disclose any information requested is falsification of your application and the Commission may rejector deny your application or take disciplinary action against your credential

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 specificnumber 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

That you understand any and all instructions related to your application;

That the information you provide is true and correct;

The Commission may reject your application if it is incomplete and it will be delayed;


FORM 41-4 (REV. 3/2016) 3

a. Have you ever been:

dismissed or,

non-reelected or,

suspended without pay for more than ten days, or

retired or,

resigned from, or otherwise left school employment

because of allegations of misconduct or while allegations of misconduct were pending?

Yes No

b. Have you ever been convicted of any felony or misdemeanor in California or any other place?

You must disclose:

all criminal convictions

misdemeanors and felonies

convictions based on a plea of no contest or nolo contendere

convictions dismissed pursuant to Penal Code Section 1203.4

driving under the influence (DUI) or reckless driving convictions

no matter how much time has passed

You do not have to disclose:

misdemeanor marijuana-related convictions that occurred more than two years prior to this application, exceptconvictions involving concentrated cannabis, which must be disclosed regardless of the date of such aconviction.

infractions (DUI or reckless driving convictions are not infractions)

Yes No

c. Are you currently the subject of any inquiry or investigation by any law enforcement agency or any licensing agencyin California or any other state?

Yes No

d. Are any criminal charges currently pending against you?

Yes No

e. Have you ever had any credential, including but not limited to, any Certificate of Clearance, permit, credential,license or other document authorizing public school service, revoked, denied, suspended, publicly reproved, and/orotherwise subjected to any other disciplinary action (including an action that was stayed) in California or any otherstate or place?

Yes No

FORM 41-4 (REV. 3/2016) 4

f. Have you ever had any professional or vocational (not teaching or educational) license revoked, denied, suspended,and/or otherwise subjected to any other disciplinary action (including an action that was stayed) in California or anyother state or place?

Yes No

5. CHILD ABUSE AND NEGLECT MANDATED REPORTING

As a document holder authorized to work with children, it is part of my professional and ethical duty to report every instance of child abuse or neglect known or suspected to have occurred to a child with whom I have professional contact.

I understand that I must report immediately, or as soon as practicably possible, by telephone to a law enforcement agency or a child protective agency, and will send a written report and any evidence relating to the incident within 36 hours of becoming aware of the abuse or neglect of the child.

I understand that reporting the information regarding a case of possible child abuse or neglect to an employer, supervisor, school principal, school counselor, coworker, or other person is not a substitute for making a mandated report to a law enforcement agency or a child protective agency.

I understand that the reporting duties are individual and no supervisor or administrator may impede or inhibit my reporting duties.

I understand that once I submit a report, I am not required to disclose my identity to my employer.

I understand that my failure to report an instance of suspected child abuse or neglect as required by the Child Abuse and Neglect Reporting Act under Section 11166 of the Penal Code is a misdemeanor punishable by up to six months in jail or by a fine of one thousand dollars ($1,000), or by both that imprisonment and fine.

I acknowledge and certify that as a document holder, I will fulfill all the duties required of a mandated reporter.

I agree

6. EMPLOYING AGENCY INFORMATION

This section must be completed for all credential, certificate, and permit types where service is restricted to an employing agency.

County CDS Code _________________________________ School District CDS Code ______________________________

Charter Sc

hool/Non-Pub

lic School or Agency/Statewide Agency Name ____________________________________________

Applications for One-Year Nonrenewable Credentials, Provisional Internship Permits, Short-Term Staff Permits, Limited Assignment Permits, and Emergency Permits (except 30-Day or Prospective Substitute Teaching Permits), must be filed through the employing agency. Employers must have an annual Declaration of Need for Fully Qualified Educators on file with the Commission prior to the submission of any applications for Limited Assignment or Emergency Permits.

1) Personal information with correct SSN, date of birth, and email address filled in on page 12) Type of credential clearly marked on page 1 (use box below for additional subject/authorization requests)3) All Professional Fitness Questions marked Yes or No on pages 3 and 44) Read and agreed to your responsibilities as a mandated reporter5) Payment (check or money order attached to the front of this form). See Credential Leaflet CL-659 for fee

schedule.

Before submitting, check application for completeness:

dcrable

Typewritten Text

dcrable

Typewritten Text

dcrable

Typewritten Text

dcrable

Typewritten Text

FORM 41-4 (REV. 3/2016) 5

Comments/Additional Subject Requests:

Checks or money orders may be made payable to the Commission on Teacher Credentialing. The Commission does not accept cash payments. All application fees are non-refundable.

Applications submitted that are incomplete or without the appropriate fee included will not be processed and will be returned.

7. OATH AND AFFIDAVIT

I solemnly swear (or affirm) that I will support the Constitution of the United States of America, the Constitution of the State of California, and the laws of the United States and the State of California. I hereby certify (or declare) under penalty of perjury under the laws of the State of California that all the foregoing statements in this application are true and correct.

Date _________________ City ____________________________________________ County ____________________ State ________

SIGNATURE OF APPLICANT __________________________________________________________________________________________

CL-888 5/2016 Page 1 of 13

DESIGNATED SUBJECTS

CAREER TECHNICAL EDUCATION TEACHING CREDENTIAL

Based on SB 1104 - Issued on or after January 1, 2009

Effective January 1, 2009, Designated Subjects Career Technical Education (CTE) Teaching Credentials may be

issued to individuals who meet the requirements for either the preliminary or clear credential as outlined below.

All applications must be submitted for processing through a Commission-approved CTE program sponsor. See

the Commission website for a list of Commission-approved program sponsors.

Authorization The Preliminary Designated Subjects CTE Teaching Credential authorizes the holder to teach in the subject or

subjects named on the credential in grades twelve and below and in classes organized primarily for adults, in

career technical, trade or vocational courses. The Clear Designated Subjects CTE Teaching Credential authorizes

the holder to teach in the subject or subjects named on the credential in grades twelve and below and in classes

organized primarily for adults, including services to English learners in Specially Designed Academic

Instruction Delivered in English (SDAIE) in career technical, trade or vocational courses.

Available subjects, also known as industry sectors, are as follows:

Agriculture and Natural Resources

Arts, Media, and Entertainment

Building and Construction Trades

Business and Finance Education, Child Development, and

Family Services

Energy, Environment, and Utilities

Engineering and Architecture

Fashion and Interior Design

Health Science and Medical Technology

Hospitality, Tourism, and Recreation

Information and Communication

Technologies

Manufacturing and Product

Development

Marketing, Sales, and Service

Public Services

Transportation

Requirements for the Three-Year Preliminary Credential Individuals must satisfy all of the following requirements:

1. Three years of work experience directly related to each industry sector to be named on the credential. One

year equals a minimum of 1000 clock hours and the experience may be full-time or part-time, paid or

unpaid. See Terms and Definitions for additional information regarding the experience requirement.

2. High school diploma requirement by one of the following methods:

a. Possess a high school diploma

b. Possess a diploma based on passage of the GED Test

c. Possess the foreign equivalent of a high school diploma

State of California Commission on Teacher Credentialing

1900 Capitol Avenue Sacramento, CA 95811-4213

Email: [email protected]

Website: www.ctc.ca.gov

http://cig.ctc.ca.gov/cig/CTC_apm/DS_cte_33.php

mailto:[email protected]

http://www.ctc.ca.gov/

CL-888 5/2016 Page 2 of 13

3. Verification, signed by the Commission-approved program sponsor, that the applicant has been apprised

of the requirements for both the preliminary and clear credentials, including the requirements of the

program of personalized preparation

4. Completed application (form 41-4)

5. Completed Live Scan receipt (41-LS), verifying fingerprints have been taken and fees have been paid,

unless fingerprint clearance is already on file with the Commission

6. Application processing fee

7. Recommendation by a Commission-approved CTE program sponsor

Requirements for the Five-Year Clear Credential Individuals must satisfy all of the following requirements:

1. Possess a valid California Preliminary CTE Teaching Credential (three-year or five-year)

2. Commission-approved program of personalized preparation that includes training in Specially Designed

Academic Instruction Delivered in English (SDAIE)

3. Verify completion of one of the following:

a. Two years of successful teaching on the basis of the Preliminary CTE Teaching Credential in the

industry sector(s) listed on the credential

b. A Commission-approved program of advanced personalized preparation as determined by the

program sponsor agency

4. U.S. Constitution requirement by one of the following methods:

a. Complete a course (at least two semester units or three quarter units) in the provisions and

principles of the U.S. Constitution. Submit a copy of the course description for evaluation

purposes.

b. Pass an examination in the provisions and principles of the U.S. Constitution, given by a

regionally-accredited college or university

5. Health education, including, but not limited to, the study of nutrition; the physiological and sociological

effects of abuse of alcohol, narcotics, and drugs, and the use of tobacco. This requirement must also

include training in cardiopulmonary resuscitation (CPR) that covers infant, child, and adult CPR skills.

6. Complete study in computer-based technology, including the uses of technology in educational settings


8. Application processing fee

9. Recommendation by a Commission-approved CTE program sponsor

National Board for Professional Teaching Standards Certification Teachers who are certified by the National Board for Professional Teaching Standards (NBPTS) in the area of

Early Adolescence through Young Adulthood/Career and Technical Education will be issued a Clear Designated

Subjects Teaching Credential in their selected subject area. Individuals applying under this route are exempt from

all other credential requirements.








http://www.nbpts.org/

CL-888 5/2016 Page 3 of 13

Individuals may apply directly to the Commission for a clear teaching credential by submitting the following:

1. Photocopy of National Board Certification


3. Fingerprint clearance (if not previously submitted to the Commission, including a completed form 41-LS

Live Scan receipt). See Credential Leaflet CL-271 for more information.

4. Appropriate application processing fee

Period of Validity The preliminary credential is valid for three years. The clear credential is valid for five years and must be renewed

online every five year renewal cycle. Once issued, there are no additional academic requirements to renew the

clear credential.

Transition from Vocational Education and Five-Year CTE Teaching Credentials Holders of Life or Clear Designated Subjects Vocational or CTE Teaching Credentials issued under previous

regulations and statutes may choose to either maintain their documents or transition to CTE credentials issued

under the provisions of SB 1104, outlined in this information leaflet. Due to significant changes to the program

standards, holders of these credentials may not qualify for the Clear CTE Teaching Credential under the new

program standards. For additional information, please see Coded Correspondence 09-01.

Transition to New Industry Sectors

Effective September 1, 2014, five of the 15 Industry Sectors listed on the Designated Subjects CTE Teaching

Credential will have new titles. The new Industry Sector titles will be issued on all first time, new type, and

renewed Designated Subjects CTE Teaching Credentials on or after September 1, 2014.

A Preliminary or Clear Designated Subjects CTE Teaching Credential originally issued prior to September 1,

2014 based on an occupation that moved to a new Industry Sector remains valid and appropriate for the service

aligned with their occupation. Employing agencies should confirm the original issuance date of the credential and

use the Crosswalk Guidance Chart in Appendix B and/or Table 2 found in Coded Correspondence 14-08 to

determine if an educator’s occupational experience is appropriate for their assigned Industry Sector.

The holder of a Preliminary Designated Subjects CTE Credential who completes a Clear program after September

1, 2014 has the option of keeping their original authorization or, if their occupation has moved, may transition to

the new Industry Sector. Educators who elect to change Industry Sectors must work with their program sponsor

to verify that the occupational training and experience held at the time the initial Preliminary CTE Credential was

recommended was appropriate for the newly aligned Industry Sector. See the guidance chart in Appendix A of

Coded Correspondence 14-08. The previously issued Industry Sector authorization will be removed from their

credential. Educators should confirm with their local employing agency whether any change in Industry Sector is

necessary for employment purposes.

TERMS AND DEFINITIONS

Work Experience

Verification of work experience means written confirmation of the applicant’s qualifying experience, signed by

the applicant’s past or present employer(s) on company letterhead that attests to and/or includes all of the

following:

1. Employer’s name, address, and telephone number

2. The working relationship of the person signing the verification to the applicant








CL-888 5/2016 Page 4 of 13

3. Beginning and ending dates of employment

4. Complete description of duties

5. A statement as to whether or not the employment was full-time (If employment was less than full-time,

an accounting of the number of hours the applicant was employed is required.)

If the applicant was self-employed or if the applicant’s experience was avocational, verification shall include a

statement, signed by the applicant under penalty of perjury, detailing the information described in 1–5 above, and

must be further substantiated, in writing, by other person(s) having first-hand knowledge of the applicant’s self-

employment or avocation, such as the applicant’s accountant, major supplier of goods, or major user of goods or

services.

At least one year of the required work experience must be within the last five years, or two years within the last

ten years, immediately preceding the issuance of the preliminary credential. 1000 clock hours shall be the

minimum required for each year of work experience. Part-time work experience may be cumulated to equate to

the required 1000 clock hours of work experience.

Completion of forty-eight (48) semester units of postsecondary vocational training related to the industry sector(s)

named on the credential may be substituted for a maximum of two of the three years of required work experience.

The course work must be verified by official transcript and may be made on a pro rata basis up to the two-year

maximum.

Additionally, one of the following may be used as one year of work experience toward meeting the three years of

required experience:

Possession of an advanced industry certificate related to the industry sector to be named on the

preliminary credential, as determined by a Commission-approved CTE program sponsor

One year of full-time general education teaching experience providing instructional services in

preschool or grades K-12 earned in a public or private school of equivalent status

An individual must have at least one year of actual work experience to qualify for the three-year preliminary

credential.

Click here for Professional Preparation Programs or visit the Commission web site @ www.ctc.ca.gov.

Reference: California Education Code, Sections 44260 and 44260.1; 5 California Code of Regulations, Sections 80034.1

and 80034.2.


http://www.ctc.ca.gov/

CL-888 5/2016 Page 5 of 13

Industry Sectors This chart is intended to be a guide. Some of the occupations, such as “drafting,” can be applied to more than one

Industry Sector. Program sponsors are encouraged to examine the work experience of the individual applying for

a credential and determine which Industry Sector best applies. Assignments should be considered in the same

way. The most important consideration is the background and the expertise of the individual. Effective September

1, 2014, some Industry Sectors have new titles, while some specific occupations moved into different Industry

Sectors. See Coded Correspondence 14-08 for more information.

Industry Sectors Pathways Specific Occupations

Agriculture and Natural

Resources

• Agricultural Business

• Agricultural Mechanics

• Agriscience

• Animal Science

• Forestry and Natural Resources

• Ornamental Horticulture

• Plant and Soil Science

• Agriculture business management and

marketing

• Agriculture mechanics

• Animal care

• Animal control

• Animal production

• Crop production

• Floriculture and floristry

• Forestry, natural resources and rural

recreation

• Landscaping

• Ornamental nursery operation

Arts, Media, and

Entertainment

• Design, Visual, and Media Arts

• Performing Arts

• Production and Managerial Arts

• Game Design and Integration

• Commercial art

• Commercial photography

• Game Design Occupations

• Multimedia production

• Performing arts occupations

• Stage technology

• Theatrical occupations

Building and

Construction Trades

• Cabinetry, Millwork, and

Woodworking

• Engineering and Heavy

Construction

• Mechanical Systems Installation

and Repair

• Residential and Commercial

Construction

• Boat building

• Carpentry

• Civil Engineer

• Concrete placing and finishing

• Construction equipment operation

• Construction inspection

• Drafting occupations

• Drywall installation

• Electrician

• Fire sprinkler installation

• Floor covering installation

• Foundry work

• Furniture making, finishing and

refinishing

• General contracting

• Glazing

• Hazardous materials occupations

• Heating, air conditioning, and ventilation

installation and service

• Heavy Equipment Operator


CL-888 5/2016 Page 6 of 13

Building and

Construction Trades

(cont.)

• Interior maintenance (residential and

commercial)

• Lathing

• Masonry

• Mechanical Engineer/Technician

• Millwork and cabinet making

• Motor sweeper operator

• Painting-construction

• Pipefitting and steam fitting

• Plastering

• Plumbing

• Pool and spa service

• Refrigeration installation and

maintenance

• Residential and commercial repair and

remodeling

• Roofing

• Sheet metal fabrication

• Structural and reinforcement ironwork

• Structural pest control

• Tile setting

• Upholstering

• Welding

• Woodworking

Business and Finance • Business Management

• Financial Services

• International Business

• Accounting occupations

• Auditor

• Banking

• Business Computing Specialist

• Business management

• Chief Financial Officer

• Customs Inspector/Broker

• Export Sales

• Financial management and services

• Human Resources Specialist

• Income tax preparation

• Insurance occupations

• International Business

• Investment Consultant

• Legal office occupations

• Office occupations

• Personnel administration occupations

• Purchasing Agent

• Secretarial/stenography occupations

• Tax preparation specialist

• Small business ownership and/or

management

CL-888 5/2016 Page 7 of 13

Education, Child

Development, and

Family Services

• Child Development

• Consumer Services

• Education

• Family and Human Services

• Child care

• Child Care Psychologist

• Consumer Services

• Counselors

• Education Administrators

• Elderly care services (non-medical)

• Family and human service occupations

• Librarian

• Personal Financial Advisor

• Preschool Teacher

• Social Outreach Director

• Teacher

• Teacher aide

Energy, Environment,

and Utilities

• Energy and Power Technology

• Environmental Resources

• Telecommunications

• Air Quality Technician

• Climatologist

• Control system maintenance and repair

• Electrical power distribution

• Electrician

• Electronic consumer products service

• Electronics assembly

• Energy Auditor

• Energy Engineer

• Energy, environment and resource

manager/technician

• Environmental Biologist/Scientist

• Hybrid microelectronics

• Hydroelectric plant operations

• Industrial electronics

• Marine power plant maintenance and

repair

• Solar Occupations

• Telecommunications Technicians

• Water treatment

Engineering and

Architecture

• Architectural Design

• Engineering Technology

• Engineering Design

• Environmental Engineering

• Air Pollution Control Engineer

• Architect

• City Planner


• Engineering occupations

• Environmental Specialist

• Field Engineer

• Manufacturing Design Engineer

• Mechanical/Electrical Drafting

• Robotics

• Structural Designer

• Surveying

CL-888 5/2016 Page 8 of 13

Fashion and Interior

Design

• Fashion Design, and

Merchandising

• Interior Design, Furnishings,

and Maintenance

• Personal Services

• Barber*

• Clothing, alteration and repair

• Cosmetologist*

• Esthetician*

• Fabric maintenance services

• Fashion Buyer

• Fashion design

• Fashion manufacturing (factory and

custom)

• Fashion merchandising

• Interior Buyer

• Interior design

• Kitchen and Bath Specialist

• Makeup Artist

• Jewelry design, fabrication, and repair

• Manicurist*

• Merchandising Manager

• Pattern Maker

• Set Decorator

• Textile design

• Textile production and fabrication

• Upholstering

Health Science and

Medical Technology

• Biotechnology

• Patient Care

• Healthcare Administrative

Services

• Healthcare Operational Support

Services

• Public and Community Health

• Mental and Behavioral Health

• Athletic trainer

• Biomedical equipment technician

• Biomedical Engineer

• Biomedical Research and Development

Specialist

• Central Service Technician

• Clinical Data Specialist

• Clinical Lab Technologist/scientist

• Clinical Simulator Technician

• Forensic Pathologist

• Community Health Professional

• Geneticist

• Diagnostic Technician

• Dental Assistant

• Dental Hygienist

• Dental Lab Technician

• Geriatric Technician

• Health Care Administrator

• Health Education Specialist

• Health Information Management

• Technician/Technologist

• Massage Therapist

• Materials Manager

• Medical/Clinical Assistant

• Mental health professional

• Medical Sonographer

CL-888 5/2016 Page 9 of 13

Health Science and

Medical Technology

(cont.)

• Nutritionist/Dietician

• Outreach Coordinator

• Phlebotomist

• Physician’s Assistant

• Physical Therapy

Technician/Technologist

• Prosthetic Technician/Technologist

• Psychiatric Technician/Psychologist

• Public health professional

• Nurse (RN/LVN/NP)

• Radiological Technician

• Rehabilitation Technologist/Therapist

• Respiratory Technologist/Therapist

• Sports Medicine Specialist

• Ultrasound Technician

Hospitality, Tourism,

and Recreation

• Food Science, Dietetics, and

Nutrition

• Food Service and Hospitality

• Hospitality, Tourism, and

Recreation

• Amusement and theme park occupations

• Customer service representative related to

amusement, theme parks, hotel and

lodging, and restaurant and food service

establishments

• Dietetics and nutrition service

• Event and conference planning

• Executive Chef

• Food and beverage production and

preparation

• Food and beverage services

• Food scientist

• Hotel and lodging occupations

• Recreation and sports entertainment

• Registered Dietitian

• Restaurant Management

Information and

Communication

Technology

• Information Support and

Services Networking

• Software and Systems

Development

• Games and Simulation

• Big Data Administration

• Computer and Information Systems

• Computer Programming

• Computer Sciences

• Computer User Support

• E-Business/E-Commerce

• Game Production

• Information Management

• Information Security

• Information Systems and Operations

• Multimedia Production

• Networking Engineer

• Network Installation and Operation

• Network Support and Maintenance

• Robotics

CL-888 5/2016 Page 10 of 13

Information and

Communication

Technology (cont.)

• Social and New Media Production and

Management

• Software and Applications Developer

• Web and Mobile Application Production

Manufacturing and

Product Development

• Graphic Production

Technologies

• Machining and Forming

Technologies

• Welding and Materials Joining

• Product Innovation and Design

• Animator

• CAD/CAM Specialist/Designer

• Commercial Photographer

• Commercial/Industrial Designer

• Computer-assisted manufacturing

• Computer Numerical Control (CNC)

Operations

• Cutter

• Digital/Graphic Artist


• Electronics assembly

• Electronic publishing

• Fitter

• Industrial ceramics manufacturing

• Machine tool operation and machine shop

• Manufacturing Engineer

• Metal fabrication

• Material/Supply Management

• Model Maker

• Plastics and composites manufacturing

occupations

• Printing and graphics occupations

• Product development, testing and

demonstration

• Production process/management

• Quality Assurance

• Robotics

• Technical illustration

• Tool and die making

• Waterfront manufacturing

• Welder

• Welding Inspection

• Welding Engineer

Marketing, Sales, and

Services

• Marketing

• Professional Sales

• Entrepreneurship/Self-

Employment

• Advertising Representative/Manager

• Business Computer Specialist

• Business Owner

• Fashion Buyer

• Floristry

• Insurance Agent/Broker

• International trade

• Marketing

• Market Research Analyst

• Office Occupations

• Public Relations Specialist

CL-888 5/2016 Page 11 of 13

Marketing, Sales, and

Services (cont.)

• Real estate

• Retail occupations

• Small business ownership and/or

management

• Small Business Repair and Maintenance

• Travel Agent

• Various Professional Sales Occupations

Public Services • Public Safety

• Emergency Response

• Legal Practices

• Court reporting

• Cyber Security

• Emergency Medical Technician

• Emergency Response Dispatcher

• Fire control and safety

• Fire fighting

• Forester

• Investigator/Law Librarian

• Law enforcement occupations

• Legal occupations (deletion of word to

expand options)

• Loss Prevention Specialist

• Paralegal

• Protective and security services

• Wildland fire services

Transportation

• Operations

• Structural Repair and

Refinishing

• Systems Diagnostics and

Service

• Airframe and power plant mechanics

• Automobile detailing

• Automotive body repair and refinishing

• Automotive brake installation and repair

• Automotive electrical systems service and

repair

• Automotive heating and air-conditioning

service

• Automotive mechanics/technician

• Automotive parts counterperson

• Automotive suspension and steering

repair

• Automotive transmission and transaxle

service and repair

• Avionics

• Bicycle repair

• Claims Adjuster

• Container Crane Operator

• Diesel equipment mechanics

• Dispatcher

• Distribution Manager

• Electric motor repair

• Engine performance technician

• Heavy equipment maintenance and repair

• Industrial maintenance

CL-888 5/2016 Page 12 of 13

Transportation (cont.) • Inspectors and Planners

• Investigator/Inspector

• Marine power plant maintenance and

repair

• Motorcycle service and repair

Production, Planning, and Expediting

Specialist

• Railroad operations

• Small engine service and repair

• Transportation occupations, travel

services

• Truck and bus driving

• Warehousing

Note: specific occupations marked with an asterisk (*) require a state license outside the purview of the

Commission.

Candidates applying based on National Board Certification in Career and Technical Education must select from

the industry sectors shown below one that aligns with their area of certification. †

National Board Certification in Career and

Technical Education Specialty Areas

Corresponding CTC Industry Sector(s)

Agriculture and Environmental Sciences Agriculture and Natural Resources

Arts and Communications Arts, Media, and Entertainment

Business, Marketing, Information Management, and

Entrepreneurship

Business and Finance;

Information and Communication Technologies;

Marketing, Sales, and Services

Family and Consumer Sciences Education, Child Development, and Family Services;

Fashion and Interior Design;

Hospitality, Tourism, and Recreation

Health Services Business and Finance;

Health Science and Medical Technology

Human Services Education, Child Development, and Family Services;

Public Services

Manufacturing and Engineering Technology Building and Construction Trades;

Energy, Environment, and Utilities;

Engineering and Architecture;

Manufacturing and Product Development;

Transportation

Technology Education Building and Construction Trades;

Manufacturing and Product Development;

Transportation

CL-888 5/2016 Page 13 of 13

† Teachers holding National Board Certification will be issued the specific California authorization based upon

the industry sector that most closely aligns with their industry certification or work experience. Individuals must

submit a copy of their NBPTS “My Profile” status page report. When logging into their NBPTS account, the

“My Profile” information may be found using a link in the upper left hand corner of the web page. This

information should be printed and attached to the copy of the National Board Certificate when applying.

NCSOE - CTE Clear Credential Checklist – Revised 2016-17

NorthCoastTeacherInductionProgram 5340SkylaneBlvd,SantaRosaCA,95403


CTEClearCredentialApplicationChecklistBasedonSB1104–IssuedonorafterJanuary1,2009

To apply for a Clear Designated Subjects Career Technical Education Credential based on a 3yr preliminary, submit the following items to the North Coast Teacher Induction Program (NCTIP) Regional Office attention: Sherry Navarro. Participant Name:________________________________________________County:________________________________

Contact Information: Email:_______________________________________Phone Number: _________________________

PROGRAM REQUIREMENTS: Evidence of Completion

1. o Possess a valid California Preliminary CTE Teaching credential (3 or 5 year) (see item # 3 for teaching requirement) 2. Program of personalized preparation requirement met through one or more of the following (check all that apply):

¨ Foundations & Orientation Class (or pre-approved equivalent course) along with one or more of the below options: ¨ Commission-approved program of personalized preparation that includes training in Specially Designed Academic

Instruction Delivered in English (SDAIE) : o Induction Year 1________ o Induction Year 2 _________ o Fire Science Program (1A & 1B)

¨ Previously Held Clear Credential ¨ Other Program/Equivalency: _________________________________________________

3. Verification of Successful Teaching on the CTE Credential – completed Verification of Experience form ¨ Two years of successful teaching on the basis of the Preliminary CTE Teaching Credential in the industry sector(s) listed on the

credential ¨ Previously Held Clear Credential (1 year teaching verification required)

4. United States Constitution Requirement met through (check one): ¨ Previously Held Ryan or 2042 Credential ¨ A university or college course (official transcript required- please attach or check box below)

o Transcript submitted with preliminary credential application ¨ Exam taken through NCTIP (no further document required)

5. Health Requirement Including valid CPR (Adult/Child/Infant) met through one or more of the following: ¨ Previously Held Clear Ryan or Preliminary 2042 Credential ¨ NCTIP Health Class (units/transcript not required) ¨ Valid CPR (Adult-Infant-Child) ¨ Nursing or medical training (copy of current CPR card & medical license required- please attach) ¨ University or college course (description of course and official transcript required- please attach) ¨ Other: _________________________________

6. Complete study in computer-based technology, including the uses of technology in educational settings: ¨ NCTIP (part of Commission-approved program – item # 2 above) ¨ Other (official transcripts required):_________________________________

Date of Credential Issuance: _________ Evidence Attached & Verified: ______________________________Date:______________ Signature: Sherry Navarro, Administrative Specialist Credential Recommendation approved:_________________________________________________________Date:______________ Signature: Karen Ricketts, Regional Director

CREDENTIAL APPLICATION REQUIREMENTS

1. Completed and Signed Application- Fully complete 41-4- Please review carefully as all corrections or additions must be initialed by the applicant. Incomplete applications may be returned to applicant.

2. $100.00 Money Order or Cashier’s Check payable to the Commission on Teacher Credentialing or CTC. Date of Completion: _________ All Required Documents Attached & Verified: __________________________________ Signature, Nicole Rosaschi, Credential Advisor

If you have questions about the Designated Subjects credential application process, please contact Nicole Rosaschi, Credential Advisor, (707) 524-2987 or [email protected].

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