Fillable TECPACEligCurrent - 9TECPAC Eligibility Application

Fill Online, Printable, Fillable, Blank TECPACEligCurrent - 9TECPAC Eligibility Application Form

Use Fill to complete blank online TENNESSEE TECHNOLOGICAL UNIVERSITY pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

TECPACEligCurrent - 9TECPAC Eligibility Application

On average this form takes 16 minutes to complete

The TECPACEligCurrent - 9TECPAC Eligibility Application form is 2 pages long and contains:

  • 0 signatures
  • 32 check-boxes
  • 48 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Tennessee Technological University

BROWSE TENNESSEE TECHNOLOGICAL UNIVERSITY FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Center of Excellence for Learning Sciences Rev. 9/2014
Tennessee State University
TECPAC ELIGIBILITY APPLICATION
Name ___________________________________________________ Soc. Sec. No. _____-_____-_______
Home Address __________________________________________________________________________
City ____________________________________________ State ___________ Zip ___________________
Primary Phone No. _____________________ Email Address _____________________________________
Gender ____ Female _____Male Date of Birth ______/_____/______
Ethnicity _____ Non-Hispanic _____ Hispanic
Race _____ Asian/Pacific Islander ____ Black ____ Native American/Alaskan Native _____ Other
_____ Two or more races ____ White
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 ______________________________________
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
.
Center of Excellence for Learning Sciences Rev. 9/2014
Tennessee State University
The Tennessee Early Childhood Program Administrator Credential is administered by Tennessee Early
Childhood Training Alliance, approved by Tennessee Board of Regents and the National Association for
the Education of Young Children (NAEYC), granted by the Tennessee State University Center of
Excellence for Learning Sciences and funded by the Tennessee Department of Human Services.
How do you think the Administrator Credential will benefit both you and your program?
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
TENNESSEE REPORT CARD INFORMATION
Family Child Care/Group
Professional
Development
Parent/Family
Involvement
Business
Management
Program
Assessment
Center
Director
Qualifications
Professional
Development
Developmental
Learning
Parent/Family
Involvement
Ratio and
Group Size
Staff
Compensation
Program
Assessment
What is your program’s overall rating? ___ 0 Stars ___ 1 Star ___ 2 Stars ___ 3 Stars
Date of Issuance __________
What is your program’s overall assessment score? ________
Date of Assessment ___________
Signature of Applicant ____________________________________________ Date ___________________
Note to Applicant: Please submit this Eligibility Application and a copy of all college transcripts to:
TECPAC ELIGIBILITY APPLICATION
To be completed by the Applicant
Tennessee Technological University
242 E. 10th Street Foundation Hall, Rm 114
Phone : (931) 372-6561
Cookeville, TN 38505
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

TECPACEligCurrent - 9TECPAC Eligibility Application

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 20 November 2019

Message

View Audit Log
Print With Audit Log
Duplicate Document