Fillable INSTRUCTIONS FOR THE REQUEST FOR PROGRAM COMPLETION VERIFICATION (California State University, San Bernardino)

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INSTRUCTIONS FOR THE REQUEST FOR PROGRAM COMPLETION VERIFICATION (California State University, San Bernardino)

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Jim and Judy Watson COE Student Services
Credential Processing (CE 102)
5500 University Parkway
San Bernardino, CA 92407-2393
Website: credentials.csusb.edu
Telephone#: (909) 537-7401
The Request for Program Completion Verification is a service offered and conducted by a Credential Analyst in order to verify
the candidate's most current credential program status. This official evaluation may be utilized by employers for employment
purposes, such as applying for a teaching permit or processing an Appeal for Extension of a Preliminary Designated Subjects
credential, etc. NOTE: CSUSB does not process formal credential recommendation to the Commission on Teacher
Credentialing (C.T.C.) for the Appeal for Extension of Preliminary Designated Subjects credentials..
Due to Credential Processing working from a remote location, the out-of-state verification form and required documentation
may be submitted via email to credrec@csusb.edu. Please note that all candidates must be officially and unconditionally
admitted to the University and to the appropriate credential program.
The results of the Program Completion Verification will be emailed (using the email address provided on the request form) to
the applicant within approximately 10 - 15 business days from the submission date of the request. Please note that this
request should be used only if the applicate is seeking an updated evaluation (after having obtained the results of a Pre-
evaluation from a Credential Analyst).
REQUEST FORM: All applicants must complete sections 1, 2, and 3 (signature required). Incomplete forms will be returned to
the applicant for completion and resubmission. Please note the subject area is section 2 is only required for individuals
completing the Single Subject or Designated Subjects credential program.
PROCESSING FEE: All applicants are required to submit confirmation of payment of the *$35 CSUSB non-refundable
processing fee. Please see the Fee Receipt for processing fee payment instructions.
REQUIRED DOCUMENTATION: Original documentation is not required for this request although it will be required for the
submission of the Application for Credential Recommendation. Applicants may refer to the appropriate credential application
packets (located on the Credential Processing web page at https://www.csusb.edu/teacher-education/credential-processing)
for the list of required documentation. It is the applicant’s responsibility to verify that all credential requirements are
successfully completed and that all required documentation is in their Program Admissions File (P.A.F.) at Credential
Processing prior to or at the time of submission of the Application for Credential Recommendation.
*Fee subject to change.
Req4PCV 11-20
INSTRUCTIONS FOR THE REQUEST FOR PROGRAM COMPLETION VERIFICATION
Jim and Judy Watson COE Student Services
Credential Processing (CE 102)
5500 University Parkway
San Bernardino, CA 92407-2393
Website: credentials.csusb.edu
Telephone #: (909) 537-7401
REQUEST FOR PROGRAM COMPLETION VERIFICATION
1. PERSONAL INFORMATION
Student Identification Number: __________________________________________
Applicant’s Name: ____________________________________________________________________________________
First Middle Last
All Former/Maiden Name(s): ____________________________________________________________________________
Address: ____________________________________________________________________________________________
Number and Street City State Zip Code
Home/Cell Phone: __
_______________________________ Work Phone: __________________________________
Email Address (MyCoyote or Personal): ___________________________________________________________________
Applicant’s signature: ____________________________________________________ Date: __________________________
Req4PCV Form 11-20
2. CREDENTIAL INFORMATION
CREDENTIAL TYPE (select one): _________________________________________________________________________________
CREDENTIAL TERM (select one): _________________________________________________________________________________
SUBJECT AREA (select one, if applicable): __________________________________________________________________________
Have you passed the RICA examination (select one)? ____________________________________________________________________
Have you passed the CalTPA cycles 1 and 2 (select one)? ________________________________________________________________
Have you completed the CalAPA cycles 1 - 3 (select one)? ______________________________________________________________
List all CSUSB program coursework for which you are currently enrolled, if applicable (Example: EDUC 603, EDUC 631):
______________________________________________________________________________________________________________
3. TRANSCRIPT AUTHORIZATION, DECLARATION AND DATE
I, the aforementioned, understand that the pre-evaluation will assist me in determining the status of my credential program and
eligibility to apply for the credential. In addition, I understand that in order to obtain a formal credential recommendation, I will
need to follow the instructions for the Application for Credential Recommendation listed at https://www.csusb.edu/teacher-
education/credential-processing. I hereby certify under penalty of perjury that all foregoing information submitted is true and
correct.
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Jim and Ju
dy Watson COE Student Services
Credential Processing (CE 102)
5500 University Parkway
San Bernardino, CA 92407-2393
Website: http://credentials.csusb.edu
Telephone#: (909) 537-7401
FEE RECEIPT INSTRUCTIONS
All applicants are required to pay the $35 non-refundable processing fee via one of the methods below.
NOTE: Confirmation of the payment must be submitted with the Application for Credential Recommendation.
IN PERSON
Pay in-pe
rson at Student Financial Services (UH-35) with payment (cash, check, money order, traveler's check, cashier's
check or pin-based ATM accepted). Due to the current COVID-19 situation, the pay in-person option is not
available.
ON-LINE (MyCoyote Account)
Pay on-line via your MyCoyote account with an electronic check or credit card (American Express, Discover, MasterCard
or VISA accepted) following these steps:
• Sign in to your MyCoyote account via the CSUSB Home page at http://www.csusb.edu/
• Select Student Center
• Select Make a Payment under the Finances Section
• Read Statement and Select Next
• Select Make Payment (top menu)
• Select College of Education Student Services (right menu)
• Select Credential Service Fee
• Manually enter fee amount (refer to the application/request instructions for the required processing fee)
• Select Add to Basket
• Checkout and make your payment
ON-LINE (Without MyCoyote Account)
Pay on-line via Campus eMarket (available for applicants that do not have a valid MyCoyote account) with an electronic
check or credit card (American Express, Discover, MasterCard or VISA accepted) following these steps:
• Go to the Campus eMarket page at https://commerce.cashnet.com/eCampus
• Select College of Education Student Services
• Enter the required information
• Check the appropriate box (refer to the application/request instructions for the required processing fee)
• Select Add to Basket
• Checkout and make your payment
FRPM 06-20
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INSTRUCTIONS FOR THE REQUEST FOR PROGRAM COMPLETION VERIFICATION (California State University, San Bernardino)

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Completed 14 June 2022

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