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Cerritos college Renewal Assistant and Associate Teacher

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Instructions and Policies/Center Based/General Child Care
Renewal Assistant and Associate Teacher
1.
In order to process your Child Development Permit funding application successfully, please assist us by reading and
following all directions carefully.
2.
The Commission on Teacher Credentialing (Commission) will only provide credentials, certificates, and
permits through an online view and print process.
3.
August 1, 2013 through July 31, 2014, the Child Development Training Consortium (CDTC) will pay the
permit application and fingerprint (Live Scan) processing fees (if applicable) for the following:
Assistant (first-time & renewal)
Associate Teacher (first time, renewal & upgrade)
Teacher (first-time, renewal & upgrade)
Upgrades from one of the three lower level permits to Master Teacher, Site Supervisor and Program
Director
Reimbursement of $70.00 for the On-line Renewal of the Teacher Permit Only is available.
Refer to the enclosed Child Development Permit Matrix (English and Spanish) and Child Development Permit Matrix
with a School-Age Emphasis to determine the education and experience required for each permit level.
4.
If you have already submitted your Child Development Permit application and fees to the Commission on Teacher
Credentialing or a County Office of Education, you are not eligible to participate in this project at this time.
5.
Applications may be submitted at any time through July 2014.
6.
An incomplete application will be returned to you unprocessed within 6 weeks.
7.
DO NOT submit any form of payment with your application.
8.
Funding is limited. At such time it is determined that the total CDTC budget will be expended, permit applications 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 eligible permits
9.
The funding for this project ends July 31, 2014.
10.
You must work or live in California.
11.
We recommend that you keep a copy of your completed Child Development Permit application for your
records.
Return completed application, along with the required documents to:
Child Development Training Consortium
1620 N. Carpenter Rd, Suite C16, Modesto, CA 95351
For assistance email: lovettc@yosemite.edu or gomezo@yosemite.edu
or call: (209) 572-6080
Do not include any form of payment with your application.
An incomplete application will be returned to you unprocessed.
Para asistencia en Español: (209) 548-5727 / Web site: www.childdevelopment.org
- 2 -
Directions and Checklist for Center Based/General Child Care
Assistant and Associate Teacher Permit Renewal Applicants Only
Assistant and Associate Teacher Level Permits Cannot be Renewed Online
Note: The Commission on Teacher Credentialing requires a new Live Scan fingerprint when upgrading/renewing
Your permit if your permit has been expired for three years or more. The CDTC will not reimburse for the additional
Live Scan Fingerprinting.
Check off each step at you complete it.
______ 1. The first step in renewing your Assistant level permit is to obtain a Professional Growth Advisor.
If you do not have a Professional Growth Advisor, go to the CDTC web site
www.childdevelopment.org to obtain one.
______ 2. You must obtain the required state form as a renewal permit applicant:
Renewal & Reissuance Application (for Renewing Existing Credentials) - Form 41-REN and the
“Instructions for Renewal.”
You may print form 41-REN from the Commission on Teacher Credentialing (Commission) web site
www.ctc.ca.gov. If you have difficulty in obtaining the required state form, please contact the Child
Development Training Consortium by email: lovettc@yosemite.edu or call: (209) 572-6080.
______ 3 Complete the Renewal & Reissuance Application – Form 41-REN:
a. Section 1 – Personal Information
Complete all sections of the Personal Information. Please do not use abbreviations. This form can be
completed on-line and printed for original signature, or you may print the form and complete in black ink.
b. Section 2 – Credential or Permit
This section requires the name of the permit you are renewing. Write out the full title of the permit you are
renewing.
c. Section 3 – Professional Clear Credential Renewal Self-Verification
You must write in the number of hours of professional growth activities you have completed. Write in your
Professional Growth Advisor’s name and telephone number. Note: This step is not required if you are
renewing an Associate Teacher Permit.
d. Section 4 – Personal and Professional Fitness
Please read information and questions carefully and thoroughly before answering. If you answer
“yes” to any question, you must refer to the “Instructions for the Application”. Additional documentation will
need to be submitted.
e. Oath and Affidavit Section
Fill out all areas of this section including the current date. Do not use abbreviations. It is very important
to sign your name in this section.
______ 4. For Associate Teacher Renewals ONLY, this permit level does not require a Professional Growth
Advisor: This permit requires units to renew, not professional growth hours. Enclose your
official/original college transcripts: Your county office of education may require sealed transcripts. In
order to renew the Associate Teacher Permit for an additional five years, you must submit original transcripts
showing the completion of an additional 15 semester units toward the Child Development Teacher Permit.
These classes must have been taken after applying for the Associate Teacher Permit the first time. All course
work must be completed with a grade of “C” or better. General Education units must be degree applicable.
Important, you can only renew the Associate Teacher Permit one time.
_______ 5. Enclose a copy of your current Child Development Permit or you can print a copy from the
Commission’s web site www.ctc.ca.gov.
_______ 6. Complete the Child Development Permit Application (located on pages 3 & 4):
The application consists of the following parts:
______ Section A - To be completed by the permit applicant – name and mailing address should be the
same on all forms submitted.
______ Section B - Employer information to be completed by the permit applicant, if applicable.
______ Section C - To be completed by the applicant’s college child development advisor – If you have
difficulty completing this step, please email lovettc@yosemite.edu or call (209)
572-6080.
______ Section D - To be completed by the county credentialing agency, usually the county office of
education – skip this question if you work in Los Angeles, Sacramento or San
Francisco counties.
- 3 -
_______ 7. Complete the “CDD Confidential Profile for Direct Service Participants” form. If completing this form
electronically, use the tab feature to enter data. Return with your Child Development Permit application to the
Child Development Training Consortium.
_______ 8. Return your completed application, along with the required documents to the Child Development
Training Consortium.
- 4 -
Child Development Permit Funding Application
CDTC Use Only
Fees: $
Section A:
To be completed by you, the applicant. DO NOT USE ABBREVIATIONS. If completing this form electronically use
the tab feature to enter data.
Section B:
Employer information to be completed by the permit applicant, if applicable.
Section C:
To be completed by your college child development advisor or qualified agency representative for assessment of
eligibility. IMPORTANT: Please contact your college Early Childhood Education department to inquire if they are
part of the VOC Project. Email: lovettc@yosemite.edu or call: (209) 572-6080 if you have difficulty completing this
step.
Section D:
To be completed by the county credentialing agency (usually the county office of education).
Take all completed, original application forms and official college transcripts (if applicable) with you.
Disregard this section if you work in Los Angeles, Sacramento, or San Francisco Counties.
Section A:
Applicant must complete and sign Section A.
Name:
Date:
Birthdate: / / (mm/dd/yyyy)
Social Security Number: (Last five digits of SS# are REQUIRED) ___ - ___ ___ ___ ___
Mailing Address:
County:
City:
State:
Zip:
Home Phone: ( )
Work Phone: ( )
Email:
Which permit are you applying for? ( Check only one )
Assistant Associate Teacher Teacher Master Teacher Site Supervisor Program Director
Are you applying with a School-Age Emphasis? Yes No
Which type of permit are you applying for? ( Check only one) This is my very first Child Development Permit
I am renewing my current permit I am upgrading to a higher level permit Downgrade On-line Renewal
Current Job Title: __ Long-Term Career Goal: Assistant Associate Teacher Teacher
Master Teacher Site Supervisor Program Director Family Child Care Own a Center Other (specify):
Gender:
Male
Female
Languages:
What languages (other than English) do you speak fluently?
What languages (other than English) do you use in your work?
Race / Ethnicity:
Asian
Black/African-American
Latino/Hispanic
Native American/Alaskan
Pacific Islander
White/Caucasian
Multi-racial
Other (specify):
Which age groups of children do you work with? ( Check all that apply )
Less than one year 1 year old 2 years old 3 years old
4 years old through pre-kindergarten School-age in before/after school programs
Do you work with children under 5 years who have disabilities or other special needs *? Yes No
* These are children (between birth and 18 years of age) who:
1. Have an IEP (an Individual Education Plan); or 2. Have an IFSP (an Individualized Family Service Plan); or
3. Have behavior, development, or health issues that affect their family’s ability to get child care services.
What is the full and complete name (NO ABRREVIATIONS PLEASE) and location of the college where you completed the majority of the
course work required for the Child Development Permit you are applying for now?
College name: State:
Are you currently a student? No Yes
If yes, which college are you currently attending?
I verify that all required documents are completed 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 understand that information I have provided may be provided to California
Department of Education, Child Development Division and/or their research partners for the purpose of evaluating this project.
Applicant’s Signature
Date
- 5 -
FOR CONSORTIUM
USE ONLY:
Live Scan:
No Yes
Rec’d Date:
File Date:
Fee Paid:
$
Child Development Permit Funding Application
Section B:
Employer Information to be completed by the Permit Applicant, if applicable
Permit Applicant’s Name:
Name of Employer or Contracting Agency:
Address:
City: Zip: _
Applicant’s Job Title: _ Applicant’s Hourly Wage: $
Program Funding Received ( Check all that apply ):
CDE/CDD Alternative Payment Voucher
CDE/CDD Direct Funded
City/Municipal
Head Start
Parent Fees
Other (Specify): ____________________________________________________
Employer Type (check only one):
Licensed Center
License-Exempt
Licensed Family Child Care Home
Exempt (Unlicensed) Home Care
Section C:
Skip this part if you are renewing any permit except for the Associate Teacher. To be completed by your college child
development advisor or qualified agency representative. Call (209) 572-6080 if you have difficulty completing this step.
IMPORTANT: Please contact your college Early Childhood Education department to inquire if they are part of the
VOC Project. The VOC Project allows participating programs to assure the Commission that an applicant has
met the requirements for the permit. Participation in the program by a community college or four-year institution
is voluntary. All six types of child development permits may be approved.
I have reviewed the application of the above named individual. I believe that the courses completed fulfill the
requirements of the Child Development Permit for which the applicant is applying.
College:
Phone: ( )
Print Name:
Title:
Email:
Signature:
Date:
Section D:
To be completed by the county credentialing agency (usually the county office of education).
Take all completed, original application forms and official college transcripts (if applicable) with you.
Disregard this section if you work in Los Angeles, Sacramento, or San Francisco Counties.
I have reviewed the application of the above named individual. All required documents are attached and ready
for submission to the Commission on Teacher Credentialing. I understand that CDTC staff does not evaluate
transcripts to ensure educational requirements have been satisfied.
Agency:
Phone: ( )
Print Name:
Title:
Email:
Signature:
Date:
Return completed application, along with the required documents to:
Child Development Training Consortium
1620 N. Carpenter Rd, Suite C16, Modesto, CA 95351
For assistance email: lovettc@yosemite.edu or gomezo@yosemite.edu
or call: (209) 572-6080
Do not include any form of payment with your application.
An incomplete application will be returned to you unprocessed.
Vendor/Organization Code 7134DTC9
Title of Training Stipend for Permit
Date ______________________ (mm/dd/yyyy)
Confidential Profile for Direct Service Participants
California Department of Education, Child Development Division, Quality Improvement Training
This training is funded through the California Department of Education (CDE), Child Development Division with Child Care Development
Fund Quality Improvement dollars. The collection of this information will help to inform CDE and other stakeholders about who
participates in professional development activities and inform state planning efforts.
These questions are asked for statistical reporting purposes only and the information collected will be used only for statistical purposes.
Your individual information is confidential and no individual identifying information will be reported.
The following three questions are asked in order to allow the CDE to collect and update information each time you participate in a
quality improvement training, without needing to collect your name. Individual information remains confidential and will not be
reported in any way. Please complete this information each time you receive this form.
1. What is your date of birth? ____/____/________ (mm/dd/yyyy)
2. In what city were you born? _________________________
3. What are the last five digits of your social security number? X X X - X ____ - ____ ____ ____ ____
Education Information
4. What is your highest level of education? Please check only one answer.
□ No high school diploma/No GED □ AA/AS (2-year college degree) □ Master’s degree
□ High School diploma/GED □ BA/BS (4-year college degree) □ Doctorate
5. If you have a college degree, is your highest degree from a foreign country?
□ Yes □ No □ I do not have a degree
6. If you have a degree, please select the area that best represents the major for any degree you have attained.
Please check all that apply.
ECE/Child or Human
Development
Education/Psychology/
Social Work
Business/Math/Science/
Health
Other
□ AA/AS/2-year college degree
□ AA/AS/2-year college degree
□ AA/AS/2-year college degree
□ AA/AS/2-year college degree
□ BA/BS/4-year college degree
□ BA/BS/4-year college degree
□ BA/BS/4-year college degree
□ BA/BS/4-year college degree
□ Master’s degree
□ Master’s degree
□ Master’s degree
□ Master’s degree
□ Doctorate
□ Doctorate
□ Doctorate
□ Doctorate
7. If you hold a current California child development permit, indicate your current level:
□ I do not have a permit □ Associate teacher □ Master teacher □ Program director
□ Assistant teacher □ Teacher □ Site supervisor
□ Children’s Center Instruction □ Children’s Center Supervision
8. If you hold a current California teaching credential, indicate which credential(s). Please check all that apply.
□ I do not have a credential □ Early Childhood Special Education □ School Nurse Services □ Other
□ Administrative Services □ Multiple Subject □ Single Subject
□ Bilingual Specialist □ Pupil Personnel Services □ Specialist Instruction
□ Clinical/Rehabilitative Services □ Reading/Language Arts □ Speech-Language Pathology
CDDParticipantProfileForm_directservice_7/27/11
Complete this form if you work in child care center,
school-age child care, family child care home, or as an
individual child care provider.
Employment Information IF YOU ARE NOT CURRENTLY EMPLOYED IN ECE, SKIP TO QUESTION #22.
9. Which best describes the setting or program you primarily work in? Please check only one answer.
□ Licensed child care center/early childhood program □ Licensed family child care home
□ License-exempt center or school-age program (e.g. Cal-SAFE, military child care, parent co-op)
□ Informal provider (family, friend, neighbor) □ Other (please specify) _________________________
10. If you work in a center or school-based ECE program, which best describes your primary position?
□ Assistant teacher/teacher aide □ Site supervisor □ Director – multi-site
□ Teacher/lead teacher □ Assistant Director □ Executive director
□ Teacher-director □ Director – single site □ Other (please specify) __________________
□ Specialized teaching staff (e.g. special education teacher, supervising master teacher)
□ Professional support staff (e.g. curriculum specialist, mental health consultant)
11. If you work in a family child care home, which best describes your primary position?
□ Owner/operator of the family child care □ Assistant in the family child care □ Other (please specify)___________________
12. What is your city of employment? _______________________________________________________________________________
13. What is your county of employment? ____________________________________________________________________________
14. What is your zip code of employment? ___________________________________________________________________________
15. Please write in (if less than one year, write in 1):
Number of years you have been employed in the ECE field ______
Number of years you have been employed with your current employer ______
Number of years you have been employed in your current position with your employer ______
16. How many paid hours per week and months per year do you work at your current job, on average?
Number of paid hours per week _________ Number of months per year _________
17. How many children are currently enrolled in your classroom or program? If you are a teacher, provide the number of
children in your classroom. If you are a director or work in a family child care home, provide the number of all the
children in your program. ___________
18. How many children are enrolled in the following age groups? Please respond to all age groups that apply. If you are a
teacher, provide the number of children in your classroom. If you are a director or work in a family child care home,
provide the number of all the children in your program.
Less than one year _________ 3 years old _________
1 year old _________ 4 years old through prekindergarten _________
2 years old _________ School-age in before/after school program __________
19. Do you currently care for children who are dual language learners?
□ Yes □ No □ Don’t know
20. Do you currently care for children who have an Individualized Family Service Plan (IFSP), an Individualized Education Plan (IEP)?
□ Yes □ No □ Don’t know
21. What is your current gross salary, for this early care and education job, (before taxes and other deductions)? Please
Respond only once – by hour or by month or by year. Wage information is collected to help the California Department of Education
better understand and report on wage levels of early care and education providers. All information will remain confidential and will
be used for statistical purposes only.
Per hour _________ or Per month ___________ or Per year _____________
CDDParticipantProfileForm_directservice_6/2/11
Demographic Information This information is collected to help the California Department of Education better understand
the characteristics and needs of people participating in their education and training programs. All information will remain
confidential and will be used for statistical purposes only.
22. What is your gender?
□ Female □ Male
23. How do you identify your race/ethnicity? Please check only one answer.
□ Asian □ Native American/Alaskan □ Multi-racial
□ Black/African-American □ Pacific Islander □ Other (please specify) ___________________
□ Latino/Hispanic □ White/Caucasian
24. What is the primary language you speak at home?
□ English □ Spanish □ Hmong
□ Mandarin and/or Cantonese □ Tagalog □ Other (please specify) ___________________
□ Russian □ Vietnamese
25. Please check all the languages you speak fluently.
□ English □ Spanish □ Hmong
□ Mandarin and/or Cantonese □ Tagalog □ Other (please specify) ___________________
□ Russian □ Vietnamese
26. A workforce registry is being piloted in several local quality improvement programs in California. A registry will track the
education and training of the early care and education workforce in order to allow program planners to better understand the
characteristics and needs of the workforce. The organizers of the pilot workforce registry would like to extend their workforce
data to include participants of the California Department of Education-sponsored professional development activities.
Do you give us permission to include the information provided on this form in the pilot registry? All information will remain
confidential.
□ Yes □ No
Thank you very much for completing the registration form!
CDDParticipantProfileForm_directservice_6/2/11
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Cerritos college Renewal Assistant and Associate Teacher

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Completed 26 December 2019

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