Center of Excellence for Learning Sciences Rev. 7/2012
Tennessee State University
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.
Southwest Tennessee Community College
Tennessee Early Childhood Training Alliance
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