Fresno State
Application for Intern Credentials
(Instructions on Pages 1-2)
I. MULTIPLE or SINGLE SUBJECT or EDUCATION SPECIALIST CHECKLIST
(CBEST or equivalent basic skills test must have already been passed)
Copy of current district employment Intern contract/agreement
___
(submit copy only – take original to Intern office)
___
Copy of Intern Admission/status letter (submit copy only)
___
Copy of Intern Agreement with the School of Education.
(submit copy only, - take original to Intern office)
___
Current Fresno State unofficial transcripts. Transcripts printed off your portal are
acceptable.
___
$25.00 money order/cashier’s check payable to “Fresno State”. Print your name and
Fresno State ID# on the money order/cashier’s check. No personal checks please.
II. ADMINISTRATIVE SERVICES CHECKLIST - CBEST must have previously been passed.
Copy of signed agreement form with the School of Education.
___
___
Copy of signed 6 pt Letter of Intent.
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Copy of district employment contract/employment agreement for an administrative position.
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Copy of current basic credential (must not be expired/expiring)
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Original employer letter verifying at least 3 years of experience on a prerequisite teaching or
services credential.
___
$25.00 money order/cashier’s check payable to “Fresno State”. Print your name and Fresno State
ID# on the money order/cashier’s check. No personal checks please.
___
Transcripts. Unofficial transcripts printed from your my.fresnostate.edu account are acceptable.
III. PPS: SCHOOL PSYCHOLOGY CHECKLIST
Copy of Certificate of Clearance or emergency permit for fingerprint clearance.
___
___
Copy of CBEST card.
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Copy of district intern contract. If your employer will not issue a contract prior to obtaining the
intern credential, you may turn in an employment agreement.
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Copy of internship agreement with the Psychology department.
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Official transcripts verifying your bachelor’s degree in Psychology (if degree not from CSUF).
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$25.00 money order/cashier’s check payable to “Fresno State”. Print your name and Fresno State
ID# on the money order/cashier’s check. No personal checks please.
___
Transcripts. Unofficial transcripts printed from your my.fresnostate.edu account are acceptable.
For questions, please contact the Credential Analyst, Sherri Nakashima
at sherrin@csufresno.edu or Kremen School, ED100
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Commission on Teacher Credentialing
After submitting your complete application packet you will receive three email notifications.
1. Authorization to pay credential fee at http://www.ctc.ca.gov/credentials/default.html. Fee:
$102.50
You will only be allowed to pay your fee after you have received this email notification. A
valid email and credit/debit card are required. The fee will be less if you hold a current
Certificate of Clearance.
•
Click the “Complete your Program’s Recommendation” button to begin your part of the
online process.
•
It is highly recommended that you review the instruction video before proceeding as you
may apply for the incorrect credential and will have to pay the fee again as there are no
refunds.
2. Payment Confirmation
Prior to receiving your final email, your local County Office of Education (COE)
credentials department will accept this payment confirmation email as a temporary
confirmation until your document number is issued.
If you have a conviction record or you have answered yes to any of the fitness questions,
your application process may be delayed as CTC verifies your information.
3. After CTC completes their review, you will receive your document number.
You must register a copy of the final CTC email with your document number at your local
COE credentials department.
The average processing time is approximately 7-10 days after payment.
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Fresno State
Application for Intern Credential
Student ID#
SS#
-
-
Date of Birth
Name
Last
First
Middle
Former Names, If Any
Mailing Address:
Number, Street, Apt#
City
Telephone:
Home
State
Cell
Zip Code
Work
Email Address
BA/BS
Major
Date Granted
Please check the credential you are applying for:
____ Multiple Subject (2042):
BAP Spanish ___
____ Single Subject
Subject Area
____ Educational Specialist Instruction
Mild/Moderate ___
BAP Hmong ___
Moderate/Severe ___
____ Administrative Services
____ PPS: School Psychology
Employed By:
District
County
First Day of Internship:
Submit pages 3-4 of the application to:
Sherri Nakashima, Credential Analyst
Kremen School of Education and Human Development
5005 N. Maple Avenue, ED701
Fresno, CA 93740-8025
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OFFICE USE ONLY – DO NOT WRITE ON THIS PAGE
CSU fee ___
FSU transcripts ___
MS/SS/SPED
Degree ___
Constitution ___
Intern Status Letter ___
District contract ____
KSOEHD Agreement ___
CSET ___
Fresno State
Coursework ____
Other IHE coursework____
CI 171 ___
LEE 172 ___
LEE 173 ___
EHD 174 ___
Certificate of Clearance fee ___
ADMIN
Copy of current
credential____
6 pt Letter of Intent ____
District contract ____
3 year experience letter ____
Admitted to program ____
CBEST____
Multiple Subject
CI 175___
CI 176 ___
LEE 177 ___
EHD 178 ___
BAP Spanish:
PSYCH
C of C ____
District contract ____
Intern agreement ____
Degree _____
CBEST _____
Single Subject
EHD 155A ___
CI 151 ___
CI 152 ___
CI 159 ___
Span 121___
Span 119___
Hmg 100___
Hmg 101___
CBEST ___
Span 134 ___
SPED
SPED 120 ___
LEE 172 ____ if needed
CLAS 116 ___
LEE 136 ___
LEE 172___
BAP Hmong:
LEE 129 ___
Anthro 123___
LEE 135 ___
LEE 172___
Date App Sent To CTC: __________________
Issuance Date: _________________________
Status Date/Date CTC Issued:_____________________
Expiration Date:________________________
Intern Multiple Subject:
BAP Spanish ___
BAP Hmong ___
Intern Single Subject
Subject Area: ______________________________
Intern Education Specialist
Mild/Mod___
Mod/Severe___
DHH___
Intern Administrative Services
Intern PPS School Psychology
District:
County:
CDS Code:
semester completed
Input Into PS
Input Into KDB
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