Fillable TECPACRenewalApplicationCurrent - TECPAC Renewal Application

Fill Online, Printable, Fillable, Blank TECPACRenewalApplicationCurrent - TECPAC Renewal 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.

TECPACRenewalApplicationCurrent - TECPAC Renewal Application

On average this form takes 25 minutes to complete

The TECPACRenewalApplicationCurrent - TECPAC Renewal Application form is 2 pages long and contains:

  • 1 signature
  • 31 check-boxes
  • 81 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. 5/2014
Tennessee State University
TECPAC RENEWAL APPLICATION
Date ____________________________
PERSONAL INFORMATION
Name ___________________________________________________
Home Address __________________________________________________________________________
City ____________________________________________ State ___________ Zip ___________________
Phone _____________________________ Email Address ________________________________________
Agency of Employment ___________________________________________________________________
Work Address ___________________________________________________________________________
City ____________________________________________ State ___________ Zip ___________________
Work Phone ___________________________________ Work Fax ________________________________
� I am the Administrator responsible for day-to-day operations.
Current Position _________________________________________________________________________
� I am no longer the Administrator responsible for day-to-day operations.
New Position ____________________________________________________________________________
HIGHER EDUCATION COURSEWORK
List all college coursework completed since Credential was last awarded. Please attach a copy of your
transcript.
Semester/Year
Course No.
Course Name
Semester Hours
Grade
PROFESSIONAL DEVELOPMENT
List the descriptions and clock hours of job specific Early Childhood, management, or administrative
professional development since the Credential was last awarded, not including college coursework. Use an
additional sheet if needed. Please be sure to attach supporting documents.
Date
Description
No. of Hours
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. 5/2014
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.
PROFESSIONAL MEMBERSHIPS
� NAEYC Exp. Date _______ � NAFCC Exp. Date _______ � TAEYC Exp. Date _______
� NSACA Exp. Date _______ � ACEI Exp. Date _______ � NBCDI Exp. Date _______
� TN ACEI Exp. Date _______ � NCCA Exp. Date _______ � SECA Exp. Date _______
� Local AEYC _________ Exp. Date _______ �Other ______________________ Exp. Date _______
PROFESSIONAL CONTRIBUTIONS
Please list, by category, any professional contributions you have made since the Credential was last awarded. Name
and describe the activity for each. Please be sure to attach supporting documents.
1. Service in a Leadership Role in a Professional Organization
___________________________________________________________________________________
___________________________________________________________________________________
2. Presentations/Trainings
___________________________________________________________________________________
___________________________________________________________________________________
3. Advocacy
___________________________________________________________________________________
___________________________________________________________________________________
4. Program Improvement
___________________________________________________________________________________
___________________________________________________________________________________
5. Writing and Publications
___________________________________________________________________________________
___________________________________________________________________________________
6. Research/Grant writing
___________________________________________________________________________________
___________________________________________________________________________________
7. Mentoring
___________________________________________________________________________________
___________________________________________________________________________________
By signing this application, I certify that all of the information on this application is correct and complete. I
understand that any misrepresentation can result in my application not being considered for renewal.
Signature of Applicant _______________________________________________ Date ______________________
For Office Candidate will renew at the following level:
Use Only �Provisional �Standard �Advanced �Master
click to sign
signature
click to edit
Center of Excellence for Learning Sciences Rev. 5/2014
Tennessee State University
Examples of Professional Contributions
The activities that demonstrate contributions to the field of Early Childhood and school-age care and education
fall into eight categories. The eight categories represent the range of professional activities in which directors
engage to improve the field. Examples follow each category.
Membership in national Early Childhood association(s)
What organizations are you a member of? Below are examples of national organizations:
• Head Start Association
• National Association for the Education of Young Children
• National Black Child Development Institute
• National Child Care Association
• National Family Child Care Association
• Tennessee Association for the Education of Young Children
• Tennessee Family Child Care Alliance
• Tennessee School-Age Care Alliance
1. Service in a Leadership Role in a Professional Organization
Think about your professional affiliations. In what ways have you served the field of early childhood/school-age
through your membership?
• Served in a leadership role in a student organization that focuses on early childhood issues
• Served on a community board as a representative of early childhood or school age care and education
• Served on a local, state, or national advisory board for an early childhood or school age organization
• Served on a local, regional, or statewide committee to promote early childhood and/or school-age issues
• Held an elected office in a local, state, or national early childhood organization
• Served on a committee for an early childhood or school-age organization to organize a conference,
community-wide advocacy event or other major event
2. Presentations/Trainings
How have you helped spread the word?
• Presented at a local CCR&R training or workshop
• Served as instructor for a college course
• Presented at a professional conference
• Presented at a high school or technical school career fair
• Served as a paid consultant/trainer for another early childhood or school-age program
• Served as an accreditation validator or observer
• Served as a credential advisor, trainer or representative
3. Advocacy
How have you advocated for young children and their families and the profession?
• Wrote a letter to an elected official about an Early Childhood issue
• Wrote a letter on an early childhood issue that was printed in a local newspaper
• Provided testimony at a public hearing on an early childhood/school age-related issue
• Provided consultation to an elected official about early childhood/school age issues
Center of Excellence for Learning Sciences Rev. 5/2014
Tennessee State University
• Arranged a food, clothing, or toy drive for a shelter, children’s home, or disaster relief effort
• Served as a community coordinator for advocacy agency or event
• Presented or provided testimony at an advocacy event
4. Program Improvement
What have you done to improve programs for children, families, and early childhood professionals?
• Successfully brought an early childhood/school age program through NAEYC, Montessori,
• NSACCA, NCCA accreditation or Head Start Program of Achievement
• Developed a written curriculum based on sound early childhood principles that was marketed to early
childhood programs
• Served as a consultant to other early childhood or school age programs in the implementation of a
curriculum approach or theory
• Served as lead consultant in the design or renovation of indoor or outdoor environments
• Created a tangible product that exhibited originality of thought and execution that helped improve early
childhood/school age programs
5. Writing and Publications
What have you put in writing to improve the field of early childhood?
• Written a student newsletter on Early Childhood topics
• Written an article or book review that was published in an early childhood/school age journal
• Served as editor of an early childhood/school age newsletter distributed in the community
• Published a book on an early childhood, school age or management-related topic
• Developed a new college-level course
• Developed new materials (e.g. handbook, manuals, curriculum) that were shared with other Programs
6. Research/Grant writing
How have you used local, state, national, or international resources to improve program quality?
• Conducted a research study on an early childhood, school age, or management-related topic as part of a
supervised thesis or dissertation
• Wrote a proposal for a grant that was funded
• Served as chairperson of a major fundraiser for an early childhood or school age related endeavor
• Reviewed proposals, was a reader, for a foundation or other grant-making agency/organization
7. Mentoring
How have you contributed or participated in mentoring in the early childhood field?
• Participated in Provider Self Assessment and Mentoring (PSAM)
• Mentored a peer child care administrator
• Participated in TOPSTAR mentoring program
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

TECPACRenewalApplicationCurrent - TECPAC Renewal 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