Item 1
Single Subject Credential Program Application
Full or Part Time
Semester of Application
Semester/Year
Student Information
Last Name
First Name
Former Name (If applicable)
Student ID
Undergraduate Degree
Institution
Graduated or Anticipated Graduation Semester/Year
Master’s Degree
Institution
Graduated or Anticipated Graduation Semester/Year
Program Information
 Single Subject - Agriculture
 Single Subject - English
 Single Subject - Music
 Single Subject - Art
 Single Subject - French
 Single Subject - Physical Education
 Single Subject - Biological Science
 Single Subject - Geological Science
 Single Subject - Physics
 Single Subject - Business Preliminary
 Single Subject – Industrial Technology
 Single Subject - Social Science
 Single Subject - Chemistry
 Single Subject - Mathematics
 Single Subject – Spanish
Field Placement (EHD 155A)
Submit the EHD 155A form with your application if you choose to complete a two semester program and:
• Have met Subject Matter Competency
• Have taken and passed CI 149
Do not submit the EHD 155A form with your application if you:
• Have NOT met Subject Matter Competency
• Have NOT taken CI 149
• Choose to complete a three semester program
Once you have met all requirements to take EHD 155A, submit the form to the Education Student Services Center in the Kremen School, ED100.
Admission Requirements (Items 1-12)
Please make sure to have all applicable items attached before submitting your application.
Letters
7. Two Letters of Recommendation
Forms
1. SS Credential Program Application
2. Admission Interview with Typed Responses
3. Advising
4. Medical Clearance
5. Orientation Attendance
Verifications
8. Applied to Fresno State (see admission requirements for exceptions)
9. Basic Skills
10. Certificate of Clearance
6. Application for EHD 155A (if applicable)
11. Subject Matter Competency (CSET/Coursework)
12. Pre-Program Field Experience
 1.
 2.
 3.
 4.
 5.
CBEST: ______ R ______ M ______ W
GPA:
_____Cum _____60 units
For Office Use Only
 6.  7.  8.  9.
CSET:
 U.S. Constitution
Admitted 
Denied 
 10.  11.  12.
 Coursework
Credential Admissions Analyst Signature
Field Placement
Supervisor:
Master Teacher:
School:
Grade:
Item 2
Admission Interview Form
Last Name
First Name
Former Name (If applicable)
Student ID
Section I (Applicant)
Please type your answers to each of the following questions as concisely and specifically as possible. The interviewers will
use the following criteria to evaluate your statement: 1) relevance of your responses to your stated goals, and 2) nature and
extent of your experiences in working with school age children.
1. List any paid experiences you have had in a classroom situation.
2. List any other paid experience with children and/or adolescents.
3. List any non-paid experiences in working with children and/or adolescents including experience obtained with
coursework.
4. List any other significant work experience.
5. What special hobbies, skills, or experiences have you had that would enhance your teaching effectiveness?
6. What personality traits do you possess that would serve to make you an effective teacher?
7. What personal characteristics do you need to change or improve so that you can become an effective teacher?
8. Describe one or two of the most important things you would like to accomplish as a teacher.
9. What circumstances led to your decision to become a teacher?
10. Where do you plan to be professionally ten (10) years from today?
Section II (Content Area Advisor)
Content Area Advisor will complete this section during interview:
Meets English speaking competency:
YES NO
Meets suitability for teaching requirement: YES NO
Contact the Single Subject Coordinator for a second interview.
Faculty Signature
Date
Faculty Comments:
Interview Referrals:
Writing Center (278-0334)
Students with Disabilities Support (278-2811)
Speech and Hearing: Accent Reduction Services (278-2422)
Health and Psychological Services (278-2734)
Writing Courses for Non-Native English Speakers (278-2097)
Item 3
Single Subject Credential Program Advising Form
Last Name
First Name
Former Name (If applicable)
Student ID
Subject Area
Two Semester Schedule:
Phase
Pre-requisites
Term/Year
Phase 1
Course
EHD 50 or equivalent
CI 149
CI 151
CI 152
LEE 157
CI 161 or
SPED 158
EHD 155A
EHD 154A
CI 161 or
SPED 158
LEE 156
Phase 2
EHD 155B
EHD 154B
Three Semester Schedule:
Phase
Pre-requisites
Term/Year
Phase 1
Phase 2
Course
EHD 50 or equivalent
CI 149 - Can be
co-requisite with Phase 1
CI 151
CI 152
CI 161 or
SPED 158
LEE 156
LEE 157
Phase 3
EHD 155A
EHD 154A
CI 161 or
SPED 158
EHD 155B
EHD 154B
Course Name
Pre-Program Field Experience
Research-Based Planning & Instruct.
Social Context of Teaching
Educational Psychology
Teaching English Learners in Sec.
Classrooms
Methods & Materials in Sec. Teach./Diff.
Instruction in Inclusive Settings
Student Teach. in Secondary Schools
Initial Student Teaching Seminar
Methods & Materials in Sec. Teach./Diff.
Instruction in Inclusive Settings
Content Area Literacy and Comm. in Sec.
Classrooms
Student Teach. in Secondary School
Final Student Teaching Seminar
Units
0-3
3
3
3
3
Course Name
Pre-Program Field Experience
Research Based Planning & Instruct.
Units
0–3
3
Substitutions
3
4
1
3
3
10
1
Total Units =34
Social Context of Teaching
Educational Psychology
Methods & Materials in Sec. Teach./Diff.
Instruction in Inclusive Settings
Content Area Literacy and Comm. in Sec.
Classrooms
Teaching English Learners in Sec.
Classrooms
Student Teach. in Secondary School
Initial Student Teaching Seminar
Methods & Materials in Sec. Teach./Diff.
Instruction in Inclusive Settings
Student Teach. in Secondary School
Final Student Teaching Seminar
3
3
3
3
3
4
1
3
10
1
Total Units =34
Applicant’s Signature
Date
Academic Area Advisor’s Signature
Date
Single Subject Advisor or Coordinator’s Signature
Date
Substitutions
Item 3
CI 161 Offerings
Subject
Agriculture
Art
Business
English
Foreign Language
Industrial Technology
Math
Math – Foundational Level
Music
PE
Science
Science – Foundational Level
Social Science
Semester Offered
Fall only
Fall only
(Must take prior to EHD 155B)
Fall only
Fall and Spring
(Must take prior to EHD 155B)
Fall only
Spring only
Fall only
Spring only
(Must have 1 CSET subtest passed prior to enrollment)
Fall only
Spring only
Fall only
Varies
Fall only
Item 4
Medical Clearance Form*
Last Name
First Name
Former Name (If applicable)
Student ID
Certification by Director of Student Health Services or Private Physician
This is to certify that the applicant has been tested for active tuberculosis within the last year and the
results were negative. (EC44336 – This student is “free from any contagious and communicable disease or defect unfitting the
applicant to instruct or associate with children.”)
Health Center Director or Private Physician's Signature
Date
Office Address (If private Physician)
*This form must be signed by Director of Student Health Services or private physician. No other type of form can be accepted.
Item 5
Credential Program
Orientation Attendance Verification
Student Information
Last Name
First Name
Former Name (If applicable)
Orientation Information
This form is to verify that this potential program candidate has been informed of:
• course requirements and sequence of the credential program;
• credential program requirements and options;
• advising procedures and how to gain additional information;
• the requirements to clear a credential;
• the responsibility of meeting application and credential deadlines.
Applicant’s Signature
Orientation Presenter’s Signature
Date of Orientation
Student ID
Item 6
Single Subject
EHD 155A Student Teaching
Field Placement Form
Semester
Student Information
First Name
Last Name
Former Name (If applicable)
Single Subject Area
Music:
Semester/Year
Student ID
 Instrumental  Choral
Subject Emphasis Area (Science Only)
Field Placement Information
Teacher candidates cannot be assigned to schools where their children attend or where family members are employed. Please provide
the family member’s school site:
Initial Student Teaching Information
1. All teacher candidates must:
a. have a valid Certificate of Clearance
b. attend an orientation held at the beginning of the semester. Details will be emailed to you prior to the beginning of the semester.
2. Placements will be coordinated just prior to the beginning of the semester.
a. Some placement options will fill quickly and it may not be possible to accommodate specific requests for assignments.
b. Location requests are considered but not guaranteed.
c. Placements are made exclusively by the Office of Professional Field Experiences and must adhere to state mandates.
Teacher Candidate’s Signature
Date
To be Completed by the Content Area Advisor:
Has the student established Subject Matter Competency?
• Yes: Indicate Method Used:  CSET or  Coursework
• No: Indicate how will student qualify?
Content Area Advisor’s Signature
Date
For Office Use Only
Credential Program Admissions Analyst
Date
Use this form as a checklist to assist you in preparing to apply to the program.
Once you have items 1-12 checked off, submit your application packet to the Education
Student Services Center in the Kremen School, ED100.
Forms






1. SS Credential Program Application
Complete the following sections on the program application:
• Student Information
• Program Information
• Field Placement
2. Signed Admission Interview with Typed Responses
3. Advising
Select and sign the appropriate Advising Form for your program.
4. Medical Clearance
A Medical Clearance Form to verify a current TB skin test. (see admission requirements)
5. Pre-Admission Orientation Attendance
Bring this form with you to the orientation to have it signed.
6. EHD 155A Application, if applicable.
Letters

7. Two Letters of Recommendation
Verifications





8. Apply to Fresno State (see admission requirements for exceptions)
If required, apply at www.csumentor.edu
9. Basic Skills Requirement
Provide a copy from the list of options.
10. Subject Matter Competency (CSET/Coursework)
11. Certificate of Clearance
Provide a copy of your Certificate of Clearance.
12. Pre-Program Field Experience
Passed EHD 50 or completed verification packet.