SST SUPPLEMENTAL PROGRAM APPLICATION The SST Program Application verifies how and when you intend to complete the state and course requirements. This form is required for your application to the Teacher Education Program. Please complete the form and submit it by uploading to your E-App at https://www.graddiv.ucsb.edu/eapp. 1. First Name: Last Name: 2. Email Address: Phone #: 3. Baccalaureate Degree Name of Institution: 4. Academic Major: 5. Single Subject Area for Credential (Check one with an X - CSET will be taken in the subject): History/Social Science Science: Biology -Level Mathematics Science: Geosciences ___Science: Physics French Latin 6. Ventura Cohort: Please check with an X if you are interested in the Ventura Cohort ______ PROGRAM REQUIRED COURSES Applicants admitted to & attending TEP will complete a course in Health Education (ED 109) during Summer Session 2015. If you have completed an equivalent course(s) at UCSB or another institution, you must submit a Course Substitution Form with a course syllabus for equivalency review. For equivalency consideration, the course descriptions are available in the UCSB General Catalog at http://my.sa.ucsb.edu/Catalog/Current/Index.aspx. If you are admitted to & attending TEP and we do not receive a Course Substitution Form & syllabus/transcript documentation that you have already completed a course in Health Education and/or Technology for Teachers by May 1, 2015 you will be assigned to these courses for Summer 2014. Please verify below if you will complete these requirements at UCSB during Summer 2015, or if you have already completed these courses at UCSB or at another institution. Course Requirement Course Name/Number College/University Quarter Grade Health Education STATE REQUIREMENTS Certificate of Clearance: You must complete the Live Scan 41-LS form and apply online by March 1, 2015 following the instructions provided in the SST Application Handbook and at the CTC website: http://www.ctc.ca.gov/credentials/online-services/pdf/web-app-tips.pdf Date applied: Date received: Subject Matter Competency: All single subject CSET subtests in your credential subject area must be passed by March 7, 2015. CSET Scores must be valid within 5 years of applying for a credential. Subtest 1, Test Date Taken: Test Date Passed: Subtest 2, Test Date Taken: Test Date Passed: Subtest 3, Test Date Taken: Test Date Passed: Subtest 4 (if applicable), Test Date Taken: Test Date Passed: Applicants must indicate UCSB (#412) as a score-reporting agency when registering for the CSET. Basic Skills Requirement: All parts of the CBEST must be passed by March 7, 2015. CBEST, Test Date Taken: Test Date Passed: Applicants must indicate UCSB (#131) as a score-reporting agency when registering for the CBEST. U.S. Constitution: A CSU degree, a course in the Introduction to American Government, or an approved U.S. Constitution passing exam from a college or university is required. Indicate below how and when you are planning to complete the U.S. Constitution requirement. If you completed a course, please write in the course below and submit a Course Substitution Form. Applicants admitted to & attending TEP must submit proof of completion by June 1, 2015. U.S. Constitution Requirement CSU Degree Course Name/Number College/University N/A Quarter Grade N/A N/A Course Exam at college or university TB Clearance and CPR: Applicants admitted to & attending TEP must submit proof of TB Clearance, and of prior CPR certification if previously completed, by June 1, 2015.