Fillable North Carolina Division of Child Development and Early Education Form dcd-0169 - Child Care Providers Education and Equivalency Form

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North Carolina Division of Child Development and Early Education Form dcd-0169 - Child Care Providers Education and Equivalency Form

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North Carolina Division of Child Development and Early Education
Child Care Providers Education and Equivalency Form (DCDEE.0169)
(Use for all positions except Administrator – See Instruction Pages) Please print or type.
DCDEE Use Only
COI Only _______________
DCDEE.0169 _Revised August 2015
Check box(es) below to apply for the following NC credentials (see Instructions Page for more information):
NC Early Childhood Credential (NCECC) NC Family Child Care Credential (NCFCCC) NC School-Age Credential (NCSACCC)
A) Applicant Information – Fill in every blank or write N/A
Check here if requesting: Status Letter Only Certificate Only
SSN (Last 4 Digits Only):
Date of Birth (mm/dd/yy):
/ /
First Name (No Nicknames):
Previous Names:
Home Mailing Address (Include Apartment or Lot # if applicable):
City (No Abbreviations):
State:
Zip Code:
Home Phone #:
Cell Phone #:
County of Residence:
( )
( )
Email Address:
B) Facility Information
Check here if not working at a child care facility
Date Employed at Facility:
County of Employment:
/ /
Facility ID # (on license):
Name of Facility:
Facility Phone #:
( )
Facility Address:
City:
State:
Zip Code:
Current Position: (check one of the positions below)
Administrator Assistant Director Lead Teacher Teacher FCCH Provider Group Leader Program Coordinator
Owner Other ___________________________________________________
Check box below if the facility where you are currently employed is either a Developmental Day or NCPreK program:
Developmental Day Facility: Age Range: Birth – 3 years 3 years & older School-Age
NCPreK Facility:
C) Educational Background – Check high school information & completed degrees. High school completion information is required
no matter what level of education has been attained above high school. Attach ALL college level official transcript(s). Photocopies,
student or internet copies and grade reports are NOT accepted. Check here if the official transcript(s) is being mailed
separately from the college/university.
High School Information (Required): HS Diploma Adult HS Diploma GED None
AA/AAS
Major:
College:
BA/BS
Major:
College:
MA/MS
Major:
College:
EdD/PhD
Major:
College:
D) Educational Qualification – Check the child care position(s) for which you request to be qualified. Refer to the chart
on page 2 for the instructions to determine what is needed to qualify for the checked position(s).
Lead Teacher
Teacher
FCCH Provider
Group Leader
Program Coordinator
This form must be signed and dated by the individual applicant:
I attest to the accuracy of the above information.
Signature_____________________________________________________ Date _______________________
Applicant should retain a copy of this form and any attached documentation for his/her records.
click to sign
signature
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Instructions for Completing the
North Carolina Education and Equivalency Form for Child Care Providers (DCDEE.0169)
(Use for all positions except Administrator and High School Equivalency Coursework)
Purpose: The
North Carolina Education and Equivalency Form
is an application used to gather identifying information and to
request evaluation of your education in order to meet education standards for specific child care position(s).
If you completed Early Childhood Education I & II in high school, you need to complete the NC DCDEE Lead Teacher
Equivalency for Approved High School Coursework form (DCDEE.0162) and submit with an official transcript from a community
college which has articulated the coursework for evaluation of your education.
If you are requesting to be qualified as an Administrator, then you must submit an original NC DCDEE Child Care
Administrators Education and Equivalency Form (DCDEE.0173) for evaluation of your education.
The form is also to be used for any future changes in personal information (name, address, phone number and/or
email), facility information, education status or additional requests to qualify for child care position(s) listed on this form.
Note: This qualification is for education requirements only. It does not indicate compliance with age, pre-service,
criminal record, medical or in-service training requirements.
Please read these instructions carefully. Retain a copy of this form and any attached documentation for your records.
General Instructions: Print clearly in ink or type your answers. If a question does not apply to you, write N/A (''Not Applicable'') in
the space. This form should be completed fully, accurately, legibly and be signed by the applicant. Incomplete forms will be returned
and delay processing of your education evaluation.
Credential Certificates: To earn approval for a credential certificate(s), all courses must be completed at a NC Community College with
a grade of C or better and receipt of a high school diploma or GED. Grade PE (Credit Received), CE (Credit by Exam) or EL (Experiential
Learning) disqualifies you from receiving the credential certificate.
Credential Certificates:
NC Early Childhood Credential (NCECC) = EDU 111 and EDU 112 OR EDU 119
NC Family Child Care Credential (NCFCCC) = EDU 111 and EDU 113 OR EDU 119 and EDU 113 OR EDU 114
NC School-Age Child Care Credential (NCSACCC) = EDU 145 and EDU 235 OR EDU 145 and EDU 263
Section A. Applicant Information: Complete all requested information in this section. Please include all previous names, including
your maiden name (if applicable). Do not abbreviate street names, cities or counties.
Section B. Facility Information: If you are currently employed in a NC child care center or family child care home regulated by
DCDEE, you must provide all of the requested information. If you are not currently employed in a NC child care facility, check the box
under facility information and do not complete the information in this section.
Section C. Educational Background: Check ALL applicable spaces to indicate completion of high school requirements and post-
secondary (college level) degrees earned as of the date this form is submitted to DCDEE. High school completion information is
required no matter what level of education above high school has been attained. High school diplomas do not need to be
submitted unless specifically requested by DCDEE.
Official transcripts* must be attached for ALL completed college level coursework, certificates, diplomas and/or degrees.
Please do not attach copies of in-service training documentation as these are not considered college coursework. Photocopies of
transcripts, student or internet copies and grade reports are NOT accepted.
*Only official transcripts from post-secondary schools which are accredited will be evaluated. Accredited is defined as an institution of
higher education having nationally recognized regional accreditation by one of the six regional accrediting agencies. (For schools outside
the U.S.A., the recognized system of the specified country’s accreditation process will be accepted). Refer to the DCDEE website for
accreditation links.
Section D. Educational Qualification: Check all child care positions for which you wish to be evaluated. To be qualified for a position
you must meet the minimum education requirements shown for each position on page 2 of these instructions. Submit official transcripts
and/or copies of any qualifying certificates, such as a BSAC or a nationally accredited credential certificate**.
**The nationally accredited credential certificate must meet the following criteria: 1)Nationally accredited and available in all 50 states,
2) Comprehensive in scope which is inclusive of the following six areas: child growth and development; professionalism; health and
safety; creation of appropriate environments that enhance physical, emotional, social and cognitive development; developmentally
appropriate learning activities; and working with families, 3) 120 clock (contact) hours of education and/or training, 4) Formal
observation and/or portfolio assessment, 5) Standardized written assessment, and 6) Individually earned.
Mail to:
NC Division of Child Development and Early Education
Workforce Education Unit
2201 Mail Service Center
Raleigh, NC 27699-2200
Questions?
Call the Workforce Education Unit
919-527-6600 or 1-800-859-0829
Website:
www.ncchildcare.nc.gov
Instructions for Education and Equivalency Form for Child Care Providers (DCDEE.0169) – Revised August 2015 – Page 1 of 2
This chart shows the education requirements for the positions listed on the Education and Equivalency form. Please note, completion of high
school or its equivalent is required for all positions.
LEAD TEACHER
TEACHER
FAMILY CHILD CARE
HOME PROVIDER
GROUP LEADER
PROGRAM COORDINATOR
High School Diploma or equivalent
AND EITHER:
NC Early Childhood Credential (earned by completion of EDU 111
and 112 or EDU 119 and meeting above criteria)
OR
One of the equivalency options listed below:
1. 1. JW Model (completion of EDU 111 and 112 or EDU 119 but did
not apply for and/or earn the NC Early Childhood Credential)
2. Tested out of the Division of Child Development and Early
Education NCECC standardized equivalency test prior to 1/1/08.
3. Completed and hold a currently active nationally accredited
credential certificate to include CDA, CCP and AMS or AMI
Montessori (attach a copy of the certificate).
4. Completed a post-secondary two-year degree or higher in
Early Childhood, Child Development, Human Growth &
Development or Early Childhood Special Education from an
accredited* institution of higher education.
5. Completed a post-secondary two-year degree or higher in any
subject area with at least 6*** sch in Early Childhood Education
and/or Child Growth & Development from an accredited*
institution of higher education.
6. Completed 12 sch (with or without a degree) in Early
Childhood, Child Development, Human Growth & Development
and/or Early Childhood Special Education programs with at least
3*** sch in Child Growth & Development from an accredited*
institution of higher education.
OR
Completed and hold a currently active Level I or higher
certification on the Early Care and Education Professional (ECE)
scale issued by the NC Institute for Child Development
Professionals (attach a copy of the certificate).
High School
Diploma or
equivalent
OR
Completed and
hold a currently
active Para-
Professional or
higher
certification on
the Early Care
and Education
Professional
(ECE) scale
issued by the
NC Institute for
Child
Development
Professionals
(attach a copy
of the
certificate).
High School Diploma or
equivalent
OR
Completed and hold a
currently active Para-
Professional or higher
certification on the Early
Care and Education
Professional (ECE) scale
issued by the NC Institute
for Child Development
Professionals (attach a
copy of the certificate).
High School
Diploma or
equivalent
AND
Basic School- Age
Care Certificate
(BSAC)
(attach a copy of
the certificate)
High School Diploma or
equivalent
AND EITHER:
NC School-Age Child Care
Credential (earned by completion
of EDU 145 and either EDU 235
or EDU 263)
OR
2 sch of Child/Youth Development
courses and
2 sch of School-Age Program
courses
OR
Lead Teacher qualification and
BSAC (attach a copy of the
certificate)
OR
Administrator qualification and
BSAC (attach a copy of the
certificate)
OR
Completed and hold a currently
active Level I or higher
certification on the School Age
Professional (SA) scale issued by
the NC Institute for Child
Development Professionals
(attach a copy of the certificate).
***The criteria for approving courses in Early Childhood Education and Child Growth & Development (ECE/CG&D) for the required six (6) sch in Option #5 and the specific three (3)
sch required in Option #6 is for the course content to emphasize developmental understanding of young children, and/or developmentally appropriate educational approaches for the
early years. When course content meets this criteria but the course title is not early childhood or age-specific, the course description will need to indicate that the course focuses on
ages between birth and five years, and/or the early years, early childhood, preschool, and/or young children. The coursework needed for completion of Option #6 (12 sch) includes
ECE/CD related coursework that does not necessarily emphasize birth through 5 years (example - General Psychology) with at least 3 sch specific to child growth & development.
sch - semester credit hours
Instructions for Education and Equivalency Form for Child Care Providers (DCDEE.0169) – Revised August 2015 – Page 2 of 2
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