Application Timelines for Summer/Fall 2010 Start:

Application Packet

California State University, Stanislaus Multiple Subject Credential Program

(Elementary School Teaching)

Summer/Fall 2010

Attendance at a MSCP information session is recommended before submitting application. Go to MSCP website http://www.csustan.edu/TeacherEd/pages/CredentialDegreeInfo/MultSubjCredProg/index.html

for dates/times.

Applications accepted: March 1- April 1, 2010 Late Applications will not be accepted. Interviews: April 16, 2010 Mandatory MSCP orientation for new teacher candidates May 14, 2010 from 5-7 p.m. in P167. Download and bring

the MSCP Handbook located at http://www.csustan.edu/TeacherEd/pages/CredentialDegreeInfo/MultSubjCredProg/index.html

Contact us at the Turlock Main Campus or Stockton Campus.

TURLOCK CAMPUS

Department of Teacher Education Demergasso-Bava Hall, Rm 330

One University Circle Turlock, CA 95382

(209) 667-3357

STOCKTON CAMPUS

California State University, Stanislaus 612 E. Magnolia St.

(Magnolia at California St) Stockton, CA 95202

(209) 467-5300

Coordinator: Anne Weisenberg, Ed.D. aweisenberg@csustan.edu

Contact us at: Teacher_Ed@csustan.edu See our web page for resources and links to assist in completing your application:

http://www.csustan.edu/TeacherEd/pages/CredentialDegreeInfo/MultSubjCredProg/index.html

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Application Packet - Multiple Subject Credential Program

Checklist for Application Folder

PLACE ALL MATERIALS IN A 9 INCH BY 12 INCH (9X12) FILE FOLDER PLEASE ONLY SUBMIT A COMPLETE FOLDER

PLEASE MAKE A COPY OF YOUR APPLICATION MATERIALS FOR YOUR OWN RECORDS _____ Attach this checklist inside the front cover of the file folder.

_____ Credential Application Fee $30 Receipt from Cashier (pay cashier at the Turlock or Stockton Campus) - Cashier's Code 1409 or $30 Check payable to CSU Stanislaus (for Application Forms sent by mail).

_____ University Graduate Application: Have you already applied to the University (if you will graduate prior to the start of credential courses or not currently admitted to the University)? Go to www.csumentor.com for links to university application forms. Fee is $55.00. Include a copy of the confirmation page. NOTE: If you are graduating after beginning to take credential program courses, you should wait to reapply at the beginning of the semester in which you will graduate.

_____ Sealed and Official Transcripts (One for each and every school attended EXCEPT CSU Stanislaus). It is required that transcripts be sent to you personally, and the sealed envelopes included in this folder. If you are new to CSU Stanislaus, you will also need one additional set of transcripts for the university graduate application.

_____ Form I Application - Be sure to complete all sections and sign.

_____ Form II Statement of Intent – Type and attach. Maximum of 2 pages. (Not required for CSU Stan Libs Majors)

_____ Form III Ethnic Identity (Optional)

_____ Form IV References – Submit 2 references - may be on the forms provided in this packet OR on letterhead

_____ Form V Verification of Early Field Experience Hours – (Not required CSU Stan Libs Majors) - May be submitted now, if 45 hrs have been completed; or at a later date, but prior to beginning the credential program.

_____ Form VI Pre-requisite Technology Proficiency Requirement Form. (Not required for CSU Stan Libs Majors). Complete as per the directions on the form.

_____ CSET Multiple Subject Examination Verification - Submit photocopy of official verification showing passage all subtests of the California Subject Examination for Teachers CSET Multiple Subject Examination OR for CSUS Liberal Studies Majors ONLY copy/printout of registration to take CSET. See MSCP Informational Pamphlet for Program requirements related to examinations.

_____ Basic Skills Requirement options: CBEST OR CSET plus writing exam OR CSU EPT/ELM with passing scores. Submit

verification of successful passage or copy/printout of registration to take CBEST or CSET plus writing exam.

_____ Second copy of the Request for Livescan Service Application Form (Form 41-LS) OR Copy of valid Emergency Teaching Credential/Permit OR Copy of valid Child Center Permit. (For a listing of Livescan locations go to http://caag.state.ca.us/fingerprints/publications/contact.html.) To print new copies of this Form, go to http://www.ctc.ca.gov/credentials/leaflets/41-LS.pdf

_____ ONLINE Application for Certificate of Clearance Form. NOT REQUIRED FOR APPLICANTS WHO SUBMIT COPY OF VALID EMERGENCY TEACHING CREDENTIAL/PERMIT OR COPY OF CHILD CENTER PERMIT. Go to https://teachercred.ctc.ca.gov/teachers/index.jsp. CLICK ON “Direct Application (non-Recommendation Only)” (found on the left side of the page) AND Choose CERTIFICATE of CLEARANCE –(in the drop-down menu on the second page) Complete the form in its totality. Using a VISA or Mastercard debit or credit card, pay the authorized transaction fee of $29.50 (PAYING A HIGHER FEE INDICATES AN INCORRECT PROCESS). Immediately following the successful submission of the online application, an e-mail will be sent containing a confirmation number and a link to the Track Payment web page. PRINT OUT THIS EMAIL AND PLACE IN YOUR CREDENTIAL APPLICATION FOLDER AS PROOF THAT YOU HAVE COMPLETED THIS STEP IN THE PROCESS.

_____ Tuberculosis Test Results - dated within the last four years (photocopies are acceptable)

_____ Letter Noting Any Exceptions to the Application Criteria (if applicable – such as gpa in the 2.5 to 2.75 range)

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FORM I - Page A Cashier's Code 1409

CALIFORNIA STATE UNIVERSITY, STANISLAUS Application for Admission to the Multiple Subject Credential Program

Name ______________________________________________________________________________ Date _______________ Last First Middle Maiden/Former Social Security Number _____________________________(required by CCTC) Birthdate ______________________________

Mailing Address ______________________________________________________________ __________________________ House/Apt. # Street City State Zip Home Phone ( )_________________________________ Work/Message Phone ( )____________________________

Cell Phone (______)________________________________ Email ________________________________________________

Answer these introductory questions: 1. Have you applied to the Multiple Subject Credential Program before? _____ No _____ Yes - When? _______________ 2. Are you a CSU Stanislaus Liberal Studies Major? ___ No ___ Yes – check which program? ____Red ___ Yellow ___ Blue 3. If you have not yet graduated: When will you graduate _____________ Classes left to complete requirements _____________ 4. Languages spoken other than English ________________________________________________________________________

Program Choice – Check only one. You may change later after learning more about these options. _____ SB 2042 Credential without a language specialization (no special emphasis) – for students who speak only English _____ SB 2042 Credential with a Spanish BCLAD emphasis (for students who speak, read, and write Spanish and want the BCLAD

specialization) - courses for this program are offered on the Turlock campus in the Fall. _____ SB 2042 Credential with a Southeast Asian Languages (Lao, Hmong, Cambodian) BCLAD emphasis (for students who speak,

read, and write Lao, Hmong, Cambodian and want the BCLAD specialization) – courses are on the Turlock campus. _____ SB 2042 Credential with a Certificate in Primary Language Support (for students who speak a language other than English and

for which there is no BCLAD program or who speak Spanish, Lao, Hmong or Cambodian but cannot read or write the language - courses are on the Turlock campus.

Site/Time For Which You Are Applying (Check your first choice only; you may change later): Turlock Campus Stockton Campus

____ Turlock Campus Daytime: Classes Morning classes available on M, T, W, Th Check One: _____ Full-time or ______ Part-time _____ Turlock Campus Early Evening: Classes meet on M, T, W, Th from 4-7 p.m. Check One: _____ Full-time or _____Part-time

_____ Stockton Campus (Methods classes in Fall only) Evening courses on Monday-Thursday from 4-7 p.m.

____ Full-time or ___Part-time

List every Junior/Community College, College, and University you have ever attended (including CSU Stanislaus).

Name/City/State of Institution Attended Dates Attended From To From To From To From To

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FORM I - Page B The purpose of this table is for the applicant to list any and all courses that he/she may have already completed so that the Credential Processing Center can give the candidate proper credit. Before completing this table, the applicant should review the section in the MSCP Informational Pamphlet at the MSCP website at http://www.csustan.edu/TeacherEd/pages/CredentialDegreeInfo/MultSubjCredProg/index.html Without this prior review the courses and requirements listed on the left column may not make sense. The Methods Courses refer to reading, math, science, & social studies methods and would only have been completed by students who had previously enrolled in another credential program. COURSE REQUIREMENT

School at Which

Taken

Course Name

Grade

If Completed: Semester/

Year Taken

If Not Completed: Semester/Year to

be Completed Upper Division English Composition (CSUS - WP Course or CBEST Writing - 41 )

American Government/Constitution (CSUS - PSCI 1201)

Child Development (CSUS – PSYC/CDEV 3140)

Second Language Experience (3 semester units of the same language or equivalent experience)

EDMS 4100 Foundations of Ed in Diverse Society (or CSUS - EDUC 4200)

EDMS 4150 Methods of Multilingual Education (or CSUS - EDUC 4400 )

Other Methods Course: Course name: __________

Other Methods Course: Course name: __________

Other Methods Course: Course name: __________

Other Methods Course: Course name: __________

Verifications/Authorizations I verify that I have read all the information in the Packet for the Multiple Subject Credential Program. I agree to abide by all the policies and procedures of the Multiple Subject Credential Program. I agree to attend all orientation meetings of the Multiple Subject Credential Program: 1) Orientation prior to admittance, 2) Teacher Performance Assessment (TPA) Orientation, 3) Student Teaching Orientation, and 4) Exit Interview. I agree to inform the Department of Teacher Education and the Credential Processing Center Office of any information pertinent to my status as a student in the credential program, including changes in address or phone number. I certify that all of the information submitted with my Application Packet is correct. I authorize CSU Stanislaus to release any information from my records that is needed by the California Commission on Teacher Credentialing and/or school districts to determine my fitness and/or eligibility to teach. I authorize CSU Stanislaus to release my name, address, and phone number to school districts for purposes of sending me job information. ______________________________________ _______________________________ Signature Date

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FORM II

CALIFORNIA STATE UNIVERSITY, STANISLAUS Department of Teacher Education • Turlock Campus and Stockton Center

Statement of Intent

NOT REQUIRED FOR CSU STANISLAUS LIBS MAJORS Directions: Using acceptable essay form, describe (1) your background in terms of coursework and activities directly relevant to teaching, (2) the aptitudes and skills you have which you feel will help you in your selected profession, (3) the strength of your commitment to your indicated profession, (4) what you believe you need to learn in the program to prepare you for teaching, and (5) your attitudes and experiences with individuals from diverse backgrounds that will assist you in the classroom. Your writing skills as well as the content of your essay will be evaluated as part of the selection process. Please use a word processor. ATTACH YOUR PRINTED PAGE(S). Maximum of 2 pages.

*********************************************************************************************************

Form III

Ethnic Identity (Optional)

Name ____________________________________________________ Last First Gender (check one): _________ Male _________ Female Date of Birth _____________________________ (used for federal Title II reports only) Please enter a code in this box:

1 - American Indian or Alaskan native; tribe __________

2 -Black, non-Hispanic, including African American

3 -Mexican-American, Mexican, Chicano

A - Central American

B - South American

Q - Cuban

P - Puerto Rican

4 -Other Latino/a, Spanish-Origin, Hispanic

J - Japanese

F - Filipino

C - Chinese

K - Korean

5 - Other Asian

D - Decline to state

G - Guamanian

H - Hawaiian

N – Samoan

6 - Other Pacific Islander

R - Asian Indian

M - Cambodian

L - Laotian

V - Vietnamese

T - Thai

S - Other Southeast Asian

7 - White

8 - Other ______________

9 - No Response

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FORM IV

TWO References/Recommendations

(Duplicate this form as needed or use letterhead) PUT IN THE APPLICATION PACKET

Personal Information - Not Confidential

The California State University, Stanislaus Multiple Subject Credential Program (MSCP) Selection and Review Committee will determine whether the applicant named below will be accepted as a candidate for the Program. To assist the committee, please provide a statement of your judgment of the candidate's qualifications for the teaching profession. Applicant's Name _______________________________________________________________________________________ Last First _______________________________________ _______________________________________________ _______________ Name of Reference (print) Address Telephone

Characteristics

Have No Information

Top 10% Excellent

Top 25% Good

Top 50% Fair

Lower 50% Poor

General Attitude Initiative/Enthusiasm Responsibility Verbal Skills Writing Skills Subject Matter Competence Rapport With Peers Rapport with Instructors/Supervisors Overall PLEASE INCLUDE STATEMENTS/COMMENTS BELOW TO SUPPORT OR ELABORATE YOUR MARKS ABOVE 1) Based on your observations, would you approve of this candidate as a public school teacher? 2) Please comment upon any positive or negative attributes that may influence the candidate's progress as an educator. ________________________________________________ _________________________________________ ____________ Reference Signature Position or Title Date

Please return to the applicant as soon as possible.

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FORM V

VERIFICATION OF EARLY FIELD EXPERIENCE NOT REQUIRED FOR CSU STANISLAUS LIBS MAJORS

Name of Student __________________________________________ Student Identification or Social Security Number _______________ Note: You may apply to the Credential Program prior to completing this requirement. However, this requirement must be met prior to taking any Level 1 – Methods Course in the Credential Program. EXECUTIVE ORDER 758, “Teacher Education Basic Credential Programs,” issued by the CSU Chancellor on October 6, 2000, requires that “The candidate shall have completed a documented field experience of at least 45 hours in a K-12 classroom or a documented field experience deemed equivalent by the campus receiving the application for admission.” This requirement may be met through a number of avenues. The following courses at CSU Stanislaus require 30 hrs of observation: LIBS 1000, LIBS 2000, LIBS 3000, EDUC 4200. IF YOU COMPLETED OR ARE ENROLLED IN ONE OF THESE COURSES, LIST THE COURSE. NO SIGNATURE IS NEEDED ON THE LAST COLUMN. Modesto Junior College, Delta College and Merced College also have courses that equate to the LIBS 1000 & 2000 courses. IF YOU COMPLETED A JUNIOR COLLEGE COURSE THAT REQUIRES FIELD EXPERIENCE, JUST ATTACH A CATALOGUE DESCRIPTION OF THE COURSE THAT SHOWS HOW MANY HOURS WERE REQUIRED. NO SIGNATURE WILL BE NEEDED. If there is no catalogue description showing the hours, you must get a signature from the course instructor. Many other courses require students to complete hours of observation/field work in schools. If you work in the schools as a volunteer, instructional aide, tutor, or substitute teacher, you may also include these hours. If the hours of Early Field Experience were not completed in one of these courses listed above, be sure to obtain a verifying signature from the professor, principal or teacher. This form should be submitted to the Credential Processing Center only after the hours have been completed. Goals of Early Field Experience: The main purposes of the Early Field Experience Requirement are to observe: 1) the texts and instructional materials used in schools; 2) the student interactions; 3) the student/teacher interactions; 4) the grouping of students for instruction; 5) the classroom management strategies used by the teacher; 6) the planning and delivery of lesson plans; 7) and how schools function.

THIS FORM MAY BE DUPLICATED AS NEEDED

TOTAL HOURS COMPLETED

Course

Number (if applicable)

Course Name or School Name

Semester Taken or

Date

Grade Earned (if applicable)

Number of Hours

Completed

Printed Name of

Professor/ Principal/Teacher

Signature of Professor/ Principal/ Teacher

Or Attach Proof of Completion

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FORM VI

TECHNOLOGY PROFICIENCY OF CANDIDATES ENROLLING IN MULTIPLE SUBJECT CREDENTIAL PROGRAM

NOT REQUIRED FOR CSU STANISLAUS LIBS MAJORS

Applicant's Name __________________________________ Identification Number ___________________________ I verify that the information provided below is accurate and that submitted materials are my own independent work. Applicant’s Signature ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ The California Commission on Teacher Credentialing requires that students applying for entry into multiple subject or single subject credential programs demonstrate proficiency with technology. You can satisfy this requirement in one of two ways: by completing one of the courses below or by submitted documentation as noted. SELECT ONE.

1. Completion of Coursework. Any coursework submitted for consideration must be completed with a grade of C/CR or above. Equivalent courses may be transferred from other institutions. If you completed a course other than those listed below, you must staple the catalog description or syllabus of the course to this form. The description/syllabus must document that the course content/assignments included the use of word processing, email, Internet searches, and one additional type of software. Note semester of completion on the appropriate line.

California State University, Stanislaus Courses Community College Courses CIS 2000 MUS 2150 Delta College CS 11 COGS 3100 MUS 2160 Delta College CS 18B CS 1000 PHED 3370 Merced College CPSC 30 CS 2000 PHED 4300 Merced College CS 24

CS 4000 Other university course

(attach documentation) MJC CMPSC 201 MJC CMPSC 203

OR Other college course (attach documentation)

2. Documentation submission demonstrating your technology proficiency. The documentation must include appropriate artifacts as noted below to demonstrate your attainment of each proficiency. Staple documentation to this form.

• Word Processor: Attach two different types of documents (essay, report, newsletter, etc.) to demonstrate that you can effectively communicate ideas in a print format. This should include effective use of format features (page numbers, alignment, font and size changes, spell-check, graphics, tables, tabs, etc.)

• Email: Include two printed samples that show you know how to successfully send and reply to messages, and that you can send and receive attachments.

• Internet: Include one sample which demonstrates that you can effectively find appropriate information from credible Internet sources, and that you can cite the source in either APA or MLA format. Write a one-paragraph narrative explaining criteria that you would use to determine if sources are valid, and explain how you search for information on the Internet.

• One additional technology tool: Include a printed sample that demonstrates your capacity to communicate through one additional technology tool such as spreadsheets, databases, presentation software, web page creation programs, or other multimedia programs.

Credential Candidates: Do not write below this line. Reviewed by: Date: Approved by: Date: The candidate has fulfilled the technology proficiency requirement. has not fulfilled the technology proficiency requirement.

REQUEST FOR LIVE SCAN SERVICE Applicant Submission

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