DOC.111.11 Revised 08/17. All previous versions are obsolete. Page 1 of 3
Fax:
410-229-0145
Maryland State Department of Education/Division of Early
Childhood Development
Maryland Child Care Credential Program
CREDENTIAL APPLICATION
Return To:
Child Care Central
PO Box 598
Baltimore, MD 21203
** Instructions for each section of this application are at the end of the application, on page 3. **
Incomplete applications will be returned.
For assistance completing the application, call Child Care Central at 1-866-243-8796 or refer to the Credentialing Booklet at
http://earlychildhood.marylandpublicschools.org/child-care-providers/credentialing
Section 1
General Information
Application Type:
First Application Renewal Update Upgrade
Section 2
Applicant Information
Party ID Number:
Social Security Number (SSN):
Date of Birth (DOB): MM/DD/YYYY
Phone Number:
Email Address:
Section 3
Employment Information
Center License Number:
Center Phone Number:
Family Child Care Provider
Registration Number:
________________________
Child Care Center Employee (Check primary position.)
Director Teacher Aide Other ______________________
Age Group (Check all that apply.):
Infant/Toddler Preschool School Age All
Section 4
Essay
Why did you become a child care professional?
Why do you want to get the Maryland Child Care Credential?
Section 5
Signature
I affirm that all information on this application and all attached documentation is true and correct. I understand that if I have had a child care
license or registration suspended or revoked I may not be eligible to participate in the Credential Program. I further understand that there
are penalties for giving false statements. I have attached all required information including documentation of training, professional activity,
and experience. My signature below makes this statement binding.
Applicant Signature
Date
This application will not be processed if the form is not signed and dated.
DOC.111.11 Revised 08/17. All previous versions are obsolete. Page 2 of 3
Section 6
Education
List all courses from your attached college grade slips/transcripts that are related to early childhood development and the college credit
hours for each.
If this is a First Application, list all related college courses ever completed.
If this is a Renewal, Update, or Upgrade, list only related college courses taken during the current credential year.
Course Title
College Credit Hours
DOC.111.11 Revised 08/17. All previous versions are obsolete. Page 3 of 3
Instructions for completing an
application to the Maryland Child Care Credential Program
Section 1
General Information
Select only one Application Type.
To be credentialed for the first time, check First Application and complete Sections 1 through 6.
To renew a current credential within the required timeframe, check Renewal and complete all Sections except Section 4.
To reactivate a credential that expired more than 30 days ago, check Update and complete all Sections except Section 4.
To move to a higher level within the credential year, check Upgrade and complete all Sections except Section 4.
Required Documentation
Enclose the following documents with your application.
Education/Training
OCC Approved Training Certificates (Completed within 5 years of application date for First Application.
Completed within the current credential year for Renewal, Update, or Upgrade.)
College grade slips/transcripts or proof of current college enrollment (No expiration regardless of datefor
First Application. Completed within the current credential year for Renewal, Update, or Upgrade.)
College degree with accompanying transcript from an accredited college or university. (Foreign degrees
must be translated and evaluated before submission.)
Professional Activities
(Must be within 12 months
of application date.)
Professional organization membership card(s)
Canceled checks
Letters of acknowledgement of participation in professional activities
Other documentation, as appropriate.(Refer to the Credential Program booklet for examples of PAUs)
Experience
Family Child Care Provider: Copy of any family day care certificate of registration, including current
certificate and copy of at least one child attendance sheet completed during the past 12 month period.
Center Staff: Letter of employment on center letterhead including position, hours worked per week and
start and end date for each position held or other documentation of current employment.
Any other documentation of experience, letters, time sheets, staff evaluation card, etc.
Section 2
Applicant Information
Answer all of the questions in this section.
Please make a note of the Date of Birth and Phone Number you enter on the form. This information will be needed to access your
credential information on the automated phone system.
Section 3
Employment Information
Answer all of the questions in this section for your current position. In the Position field, choose either Family Child Care Provider or Child
Care Center Employee. If you are an employee, answer the remaining questions in that section.
Family child care providers must submit a certificate of registration and 1 attendance sheet dated within the last 12 months. Child
care center staff must submit a letter of employment on the center's letterhead including position, hours worked per week and
start and end date for each position held.
Section 4
Essay
If this is your first application, either type or hand write an essay on the question you selected and include it in your application packet.
Section 5
You must sign and date the application for it to be considered complete. Incomplete applications will be returned.
Section 6
Education
List all courses from your attached college grade slips/transcripts that are related to early childhood development and the college credit
hours for each. If this is a First Application, list all related college courses ever completed. If this is a Renewal, Update, or Upgrade, list only
related college couses taken during the current credential year.
Additional Information
For additional information on the Maryland Child Care Credential Program or completing this application refer to the Credentialing Booklet
at http://earlychildhood.marylandpublicschools.org/child-care-providers/credentialing.
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome