Application for: FALL year
SPRING
year
SUMMER year
A P P L I C A N T D A T A S H E E T
Name
Student ID #:
Last First Middle
Social Security Number:______________________
Fresno State Email:
Date of Birth: ____________________
Phone Number___________________________
Degree: ________________________________________________________________________________
Major Institution Semester & Year graduated OR
Anticipated Graduation Semester & Year
Credential Subject: _____
1.
2.
3.
4.
5.
6.
(Please submit paperwork in the order below.)
D O N O T W R I T E B E L O W T H I S L I N E
Application Data Sheet 7.
Letters of Recommendation (Two Required)
Documentation of University Application
Single Subject Orientation Attendance Form
Verification of Pre-Program Field Experience
8.
9.
Advising Form
Certificate of Clearance
10.
Application for EHD 155A
CBEST Scores R____M____W____
(California Basic Education Skills Test)
Signed Admission Interview Form/Typed Responses
Signed Medical Clearance Form
11.
Subject Matter Competency
(required prior to EHD 155A)
CSET 1____ 2____ 3____ 4____ (must submit scores OR
Coursework ____ (verified on Application for EHD 155A)
Admitted
Denied
Technician’s Signature
Technician’s Signature
GPA: Cumulative
Last 60 Units

U.S. Constitution
1
9/24/2013 Single Subject Credential

Application for: FALL year
SPRING
year
SUMMER year
A D M I S S I O N I N T E R V I E W F O R M
Name
Last First Middle
Student ID # _____________________ Fresno State Email:______________________________________
Telephone: Home_______________ Cell ___________________ Date of Birth:____________________
Gender:

Male

Female
You must schedule your interview with your academic area advisor first. Once your academic area advisor signs your form and you submit a complete application, you will be contacted to schedule your interview with the program coordinator.
Please answer 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. Please word process your responses.
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?
Meets English speaking competency:

YES

NO
Comments:
Meets suitability for teaching requirement:

YES

NO
Comments:
Coordinator Signature Date
Referrals Made At Interview:
Writing Center for Native Speakers (278-0334)
Writing Courses for Non-Native English Speakers (278-2097)
Meets English speaking competency:

YES

NO
Comments:
Meets suitability for teaching requirement:

YES

NO
Comments:
Academic Area Advisor Signature Date
Services for Students with Disabilities (278-2811)
Speech and Hearing: Accent Reduction Services (278-2422)
Health and Psychological Services (278-2734)
2
9/24/2013 Single Subject Credential

Application for: FALL
year
SPRING
year
SUMMER
year
M E D I C A L C L E A R A N C E F O R M
Name
Student ID #
Fresno State Email
Last First Middle
Date of Birth Gender:

Male

Female
C
ERTIFICATION BY
M
EDICAL
P
ROVIDER OF
S
TUDENT
H
EALTH
S
ERVICES OR
P
RIVATE
P
HYSICIAN
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.”)
Date Health Center Director or Private Physician's Signature
Office Address (If private Physician)
3
9/24/2013 Single Subject Credential

Name: _________________________________________________________ Subject Area: _________________
Last First Middle
Two Semester Schedule:
Phase
Pre-requisites
Term/Year
Phase 1
Phase 2
Course Course Name
EHD 50 or equivalent* Pre-Program Field Experience
CI 149
CI 151
CI 152
LEE 157
CI 161 or
SPED 158
EHD 155A
EHD 154A
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
CI 161 or
SPED 158
LEE 156
EHD 155B
EHD 154B
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
Total Units =
Units Substitutions
0 - 3
3
3
3
3
3
4
1
3
3
Three Semester Schedule:
Phase
Pre-requisites
Term/Year
Phase 1
Phase 2
Phase 3
Course Course Name
EHD 50 or equivalent* Pre-Program Field Experience
Research Based Planning & Instruct. CI 149 Can be co-requisite with Phase 1
CI 151 Social Context of Teaching
CI 152
CI 161 or
SPED 158
LEE 156
LEE 157
EHD 155A
EHD 154A
CI 161 or
SPED 158
EHD 155B
EHD 154B
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
10
1
34
Units Substitutions
0 – 3
3
3
3
3
3
3
4
1
3
10
1
Total Units = 34
Additional coursework required for Subject Matter Competency: _________________________________________
Date
Date
Date
9/24/2013 Single Subject Credential
Applicant’s Signature
Academic Area Advisor’s Signature
Single Subject Advisor or Coordinator’s Signature
4

PRELIMINARY SINGLE SUBJECT CREDENTIAL PROGRAM ADVISING FORM
Agriculture
Art
Fall only
Fall only
( Must take prior to EHD 155B)
Business
English
Foreign Language
Industrial Technology
Math
Math – Foundational Level
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)
Music
PE
Science
Science – Foundational Level
Social Science
Fall only
Spring only
Fall only
Varies
Fall only
Notes:
* EHD 50 Equivalent - May be met by an approved waiver (application at website) http://www.csufresno.edu/kremen/documents/credential/EHD50WaiverRevised.pdf
•
You must register for LEE 156 (Content Area Literacy and Communication in Sec. Classrooms) and EHD 154A
(Initial Student Teaching Seminar) along with EHD 155A (Student Teaching in Secondary School).
•
Letter Grade Requirement: Professional preparation courses (EHD, CI, LEE, SPED or equivalent) except those only offered for CR/NC, must be taken for a letter grade and a 3.00 GPA in all professional preparation courses must be maintained with no grade lower than a “C.”
•
A subject matter preparation program must be completed or the California Subject Examination for Teachers
(CSET) must be passed prior to beginning EHD 155A Student Teaching in the Secondary School. Passing
CSET scores must be used toward an internship or preliminary credential within five years of the test date.
•
Professional education courses must be completed no more than ten (10) years prior to credential application
(not program application).
•
Constitution Requirement – In planning the credential program, be certain the U.S. Constitution requirement has been met. Check with your advisor. You must have received a “C” or better in the U.S. Constitution course.
•
To clear this credential you will be required to complete an Induction Program as advised by your employing district (SB2042). Most school districts are aligned with Beginning Teacher Support and Assessment (BTSA) for the induction process.
•
All requirements are subject to change.
5
9/24/2013 Single Subject Credential

Dear Prospective EHD 155A Student:
Welcome to the teaching profession! EHD 155A Initial Student Teaching will be your first opportunity to work in your profession. EHD 155A Student Teaching in the Secondary School begins on the first day of instruction and ends on the last. Student teaching requires a daytime commitment of three hours per day.
Week 1 Week 2-15
EHD 155A
Workshops
8-11am
EHD 155A
Mon – Fri
8-11am or 12-3pm
To begin the semester, we have scheduled an important and mandatory orientation on the first day of the semester in the Peters Auditorium in the Craig School of Business from 8:00-111:00 a.m.
At this orientation you will be welcomed, oriented and assigned a university supervisor.
This semester will be one filled with challenges, successes, support and long hours. You will have additional meetings every morning during the first four days of instruction. After these meetings are completed you will begin your daily student teaching.
In addition to completing the application, you must register for this course. You will receive instructions about registering for this and other credential courses by email.
If you have any questions, please feel free to make an appointment to see me by calling 278-0300 or email me at nakhavan@csufresno.edu
. We look forward to meeting with you when the semester begins.
Sincerely,
Dr. Nancy Akhavan, Coordinator
Single Subject Credential Program
Education Student Services Center
California State University, Fresno • Education Building, ED 100
5005 North Maple Avenue M/S ED701 • Fresno, California 93740-8029 www.FresnoState.edu/Kremen
9/24/2013 Single Subject Credential
6

Plan to enroll in EHD 155A in: FALL SPRING year year
A P P L I C A T I O N F O R E H D 1 5 5 A
Name
Student ID #
Last First Middle
_____________________________________________
Maiden Name
Address: Mailing_______________________________________________________________________________
Permanent
Telephone Home
Fresno State Email
Number, Street, Apt# City State Zip
____________________________________________________________
Number, Street, Apt# City State Zip
Cell
Gender:

Male

Female
Date of Birth
Single Subject Area
Subject Emphasis Area (Science Only)
Music: Instrumental Choral
All applicants who have cleared are required to attend a general orientation meeting which is held at the beginning of the semester. Information regarding meeting date, time, and location will be sent to the Fresno State email addresses of enrollees who have cleared for admission.
Student Teaching Placement Request
Indicate first, second, and third choice for assignment by indicating “1”, “2”, and “3” next to preferred locations.
(Many EHD 155A students will be placed in middle schools.)
AREA
Fresno
TIME BLOCK
8:00 – 11:00 a.m. ______
Clovis
Visalia
8:00 – 11:00 a.m. ______
8:00 – 11:00 a.m. ______
Note: Teacher candidates cannot be assigned to schools where their children attend or immediate family members are employed.
Madera
Sanger
8:00 – 11:00 a.m. ______
8:00 – 11:00 a.m. ______
_____________________________________
Family Member’s School Site
Central 8:00 – 11:00 a.m. ______
The process of determining placements will not start until teacher candidates have met all admission requirements and are registered for the course. Some placement options will fill quickly.
Location requests are considered but not guaranteed.
Persons with disabilities who anticipate needing accommodations at their school site should contact the Field Placements Office at (559)
278-0315 or fieldplacements@csufresno.edu
the semester prior to entering student teaching.
To be completed by the Academic Area Advisor:
1.
Has the student established Subject Matter Competency?

Yes

No
2.
If the answer is YES indicate method used: Test(s) ___ or subject matter preparation program (coursework)
3.
If the answer is NO, how will student qualify?
Date Student’s Signature
____________ ____________________________________________________
Date Academic Area Advisor’s Signature
For Office Use Only:
Admissions Technician___________________________________ Date____________
7
9/24/2013 Single Subject Credential

1. Print this application.
N
Y
A
R
T
:
2. Include the additional documentation required.
3. Place documents in order as listed on the applicant data sheet.
4. It is recommended that you make a copy of this entire application for your records.
5. Bring the completed application to the Education Student Services Center, Education
Building, Room 100, prior to the application deadline date or mail to:
Kremen School of Education and Human Development
California State University, Fresno
Education Student Services Center
5005 North Maple Avenue, MS ED301
Fresno, CA 93740-8025
6. Once application has been submitted, begin checking your California State University,
Fresno email regarding your application status.
Prior to applying for a Preliminary Single Subject credential you must:
1.
Complete 2042 Single Subject credential coursework with a minimum program GPA of 3.0 and pass all of the
Teacher Performance Assessments (TPAs).
2.
Demonstrate Subject Matter Competency.
3.
Pass CBEST.
4.
Complete a bachelor’s degree from an accredited institution.
5.
Complete a course in the U.S. Constitution or pass an approved exam.
6.
Document the Certificate of Clearance.
7.
Complete CPR certification.
A Preliminary Single Subject credential may be awarded when the above requirements have been met.
ONLY when you are ready to apply for your Preliminary Single Subject credential and you have questions, contact the
Credential Analyst Office:
Sherri Nakashima
(559) 278-0299 sherrin@csufresno.edu
ANY QUESTIONS?
Contact the Education Student Services Center at (559) 278-0300 or visit the Education
Building, Room 100, at California State University, Fresno.
A L L R E Q U I R E M E N T S A R E S U B J E C T T O C H A N G E D U E T O N E W
L
E G I S L A T I V E
M
A N D A T E S
.
9/24/2013 Single Subject Credential
8