TECPAC ELIGIBILITY APPLICATION
To be completed by the Applicant
Name ___________________________________________________ Soc. Sec. No. _____-_____-_______
Home Address __________________________________________________________________________
City ____________________________________________ State ___________ Zip ___________________
Primary Phone No. _____________________ Email Address _____________________________________
Agency of Employment ___________________________________________________________________
Work Address ___________________________________________________________________________
City ____________________________________________ State ___________ Zip ___________________
Work Phone ___________________________________ Work Fax ________________________________
Current Position _________________________________________________________________________
How many years have you held this position? _________
How many years total have you been a Director? _________
Is your program nationally accredited? ________ If so, by which organization:
____ NAEYC ____ NAFCC ____ NECPA ____COA ____ Other: ________________________________
Which TECTA Orientation(s) have you completed? Please check all that apply.
____ Administrator ____ Family Child Care ____ Center-Based ____ Infant/Toddler ____School-Age
Please indicate your highest level of educational attainment.
____ High School Diploma or GED
____ CDA Preparation Coursework
____ Child Development Associate Credential (CDA)
____ Some Early Childhood Education academic coursework
____ Technical Certificate
____ Associate Degree: Major ______________________________________
____ Bachelor Degree: Major ______________________________________
____ Graduate Degree: Major ______________________________________
How do you think the Administrator Credential will benefit both you and your program?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Signature of Applicant ____________________________________________ Date ___________________
Note to Applicant: Please submit this Application and a copy of all college transcripts to:
The Tennessee Early Childhood Program Administrator Credential
(TECPAC) is the recognition awarded to early childhood administrators who
have demonstrated the specific competencies for effective leadership and
management through academics, experiences, and portfolio assessment.
Center of Excellence for Learning Sciences Rev. 2/2011
Tennessee State University
TRANSCRIPT REVIEW
For Office Use Only
The Tennessee Early Childhood Program Administrator Credential is administered by Tennessee Early
Childhood Training Alliance, approved by Tennessee Board of Regents and the National Association for
the Education of Young Children (NAEYC), granted by the Tennessee State University Center of
Excellence for Learning Sciences and funded by the Tennessee Department of Human Services.
POINT OF ENTRY RECOMMENDATION
Based on the Candidate’s current education and experience level
Meets candidacy eligibility and has been assigned to an Administrator Credential Specialist
Status is Pending Academy. ____/____/______
Meets Credential eligibility at the level of:
Provisional
Standard
Advanced
Master
Will design a Professional Development Plan to meet candidacy requirements ____/____/______
Currently ineligible for the Administrator Credential
COURSEWORK REQUIREMENTS
Early Childhood Semester Hours Completed ________
Early Childhood Semester Hours Needed ________
Administration/Management Hours Completed ________
Administration/Management Hours Needed ________
Site Coordinator Signature________________________________ Date _______________
Center of Excellence for Learning Sciences Rev. 2/2011
Tennessee State University
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