SS Fall 2019

Transcript

1 ATTENTION STUDENTS! New requirements have been of implemented for the Division Education Credential admissions process. We strongly advise you to read through the application packet. Applicants will need to pass the CBEST exam prior to receiving schedule codes in August 2019. 1 Rev. 11/26

2 SAN UNIVERSITY/IMPERIAL VALLEY DIEGO STATE DIVISION OF EDUCATION SINGLE SUBJECT SB 2042 CREDENTIAL APPLICATION PACKET that you will need to apply for admission to the Division In this packet, you will find most of the materials of State at San Please carefully review our program information University/Imperial Programs Education Diego Valley. materials. allow time to gather the required application adequate and procedures application and yourself with the corresponding stipulated requirements is a minimum criterion and Completion of the application materials Factors ensure as professional judgment of the Admissions and Retention Committee and does not admission. such date by which admission requirements are fully met may determine admission. An analytical essay and an oral for process. are please note that each student is responsible as part knowing all required of the interview In addition, . It is highly recommended that each Bulletin of the Graduate Division outlined in the of the rules and regulations the program advisor, prio r to applying to our student meet with program. admission: February - March APPLICATIONFILINGPERIODS: Fall - October Spring admission: September Although candidates may submit applications at any time during the application period, early submission applications to facilitate faculty is encouraged process. Departmental the may be packets application of complete review deadline on a case by case basis. Incomplete applications will not be accepted, with the exception of accepted after the pending test scores (see “Exams”), transcripts, and letters of recommendations being sent directly to the Division of by the Division of Education for applications to be considered for Education. All outstanding items must be received tings (degree -requisite grades may be pending). pre pos and admission APPLICATION MATERIALS: Your required materials must be submitted as a packet in the designated order to the Division of application and all WF 169 or WF 179) during regular office hours or by registered mail. You must initial one box in each Education (in the on as evidence that you have provided, or are in the process of providing the section departmental application materials. required via application by mail, please send prefer materials materials “Registered Mail, Return Receipt your to submit If you all and filing date. The Division of Education office will assume no responsibility for receipt of Requested” to ensure receipt fee as a personal check, cashier’s your $25.00 mailed materials sent without such a request. Please include application cash only The Division of Education will not accept to SDSU. or credit/debt cards. check or money payable order as neatness, overall of the application’s presentation, such quality clarity, and thoroughness to the Factors contributing components in the faculty’s evaluation and review of each application. are important UNIVERSITY ADMISSION: submit Graduate/Post -baccalaureate application to be admitted CSU Diego State University You a separate must to San student. CSU Graduate/Post as a post applications are available online -baccalaureate or graduate -baccalaureate //www2.calstate.edu/apply be submitted. Online Application not . Appropriate application fees must https: at required for Spring Admissions. Bulletin of the Graduate Division for details on university policies, It is your responsibility to read and review SDSU’s Bulletin descriptions, of fees. You may obtain a copy of the listing of the Graduate Division from and course requirements, Aztec Bookstore (760) 768 -5574 or view it online at http://www.ivcampus.sdsu.edu/information/catalog/ the SDSU 2 /18 Rev. 11/01

3 TESTING REQUIREMENTS: on skills competency as demonstrated through passing Skills: Basic the California Basic Educational Basic scores Subject Examination for Teachers (CSET) with writing component or other CTC Skills Test (CBEST) or the California Basic Skills Examinations See the credential analyst, Betty Wong, for further information options for meeting approved basic requirement. the skills CBEST: Applicants are REQUIRED to submit a photocopy of passed or attempted score reports for CBEST along with the admission program application. The Basic Skills requirement needs to be fulfilled prior to submitting a Student Teaching Application. CSET Exams for Single Subject: If you did not complete an approved single subject waiver program through a appropriate California you will need to take the or university, CSET Exam. Candidates are REQUIRED to submit college without or attempted score reports along with a Student Teaching Application. No applications will be processed passed a any passing CSET score reports. Once the Student Teaching Application has been submitted, candidates will be given CSET test scores. pending pending item deadline for any a California If you approved single subject waiver program through an college or university, you are completed required to submit an official Waiver form clearing you of the CSET requirement. CSET are required to submit a photocopy of Basic Skills and Applicants attempted score reports along with your admitted application. Applicants can be conditionally prior to passing requisite exams, however, candidates cannot score continue teaching until all exams are passed and student reports have been submitted. You are responsible with for submitting a photocopy of your score reports directly to the Division of Education in a timely manner . Scores for reported through the testing agency are in roster format to SDSU research purposes only, and will not be used for at the Division of Education. your individual file . 3 /18 Rev. 11/01

4 NEXT STEPS: Once applications are received, they will be processed by the Division of Education office. If your file is complete, your it will be reviewed by process can take several weeks the members of the Admissions and Retention Committee. This you will be sent an email outlining the depending on the time of year. If your file is incomplete missing Once the Committee has reviewed yo ur file, you will be sent a letter documents/requirements. notifying you of your admission status to the program. Candidates are responsible for assuring that all materials have been delivered to the Division of Education in a timely only fashion review by the Admissions & Retention Committee. An applicant will be eligible for program admission for received when required application materials have been all and approved. INSTRUCTIONSFORAPPLYING: DIVISION OFEDUCATION Mailing Address: two 1. Retain these first pages reference. for future San Diego State University/Imperial Valley Division of Education of your application and all accompanied 2. Make a copy records. your materials for Betty Wong ATTN: 720 H eber Avenue Calexico, C alifornia 92231 3. of Submit your application to the Division office in WF 169 or 179. When you Education D.O Clarissa T er an .E. Administrative Assistant: o our office g we will your application to submit 79 oom 1 st culty Building, R Fa Office: We you to hrough all the paperwork with make t 12 55 Phone: ( 76 0) 768- (760) 768-5 52 9 Fax: complete. sure it is [email protected] s dsu.edu Email: ctera https://ivcampus.sdsu.edu/doe Website: dential Analyst: Betty W ong Cre D.O.E. Office: West Faculty Building, Room 169 Phone: (7 60 ) 76 8-5 551 : [email protected] Email n/Office Hours: Walk-i Monday – 4:30 p.m. Friday 10:00 a.m. – 4 /18 Rev. 11/01

5 SDSU VALLEY – IMPERIAL DIVISION OF EDUCATION SINGLE SUBJECT SB 2042 CREDENTIAL PROGRAM APPLICATION Spring Fall (Submit to WF 169 or 179) Year or 1. INFORMATION FORM (Please type PERSONAL fill out electronically and print out) you Should or preparation change your address, phone number or email address during the application process program, you must notify the Division of Education and the SDSU Office of the Registrar. Changing information with the both Office of the Registrar does not ch ange your record with the Division of Education. Legal me N MIDDLE LAST FIRST Red ID DOB Social Security # (If you have one) Gender Ethnicity (Optional) All Former Names Mailing Address STREET ZIP STATE CITY Permanent Address ZIP STREET CITY STATE Home Phone Other Phone E- mail Addre ss T eaching Subject Area: on Optional: Data gender and ethnicity requested for statistical reporting purposes only. Use appropriate ethnicity code listed. (See Supplemental Information) 1 with Application materials) required submit and (detach Rev. 11/01/18

6 to this Please initials that the following items are attached your application packet in the following with acknowledge order: BACHELOR’S DEGREE 2. Name of institution granting bachelor's degree Date deg ree was/will be granted Major If your bachelor’s degree is pending at the time the application is submitted, you must provide an updated official transcript (unofficial from SDSU) with your degree posted for both the Division of Education and SDSU Graduate Admissions prior to the start of the credential program. 3. TB TEST (Initial box below) an law requires that candidates verify that they do not have active State case of tuberculosis while participating on a and school tests are valid for four years TB must remain valid throughout the credential program. site. I have attached a copy of verification of a negative TB test or chest x- ray from a private physician, HMO or other health agency from within the past 4 years. below) 4. CERTIFICATE OF CLEARANCE (Initial one box professional personal school this through in a public service for fitness and All candidates are required to verify their this state review. (Excerpts from the Education Code regarding federal clearance are listed toward the end of this and application) the Completed - attached one of the following certificates/permits/credentials issued by I have California Commission on Teacher Credentialing (CTC). of Clearance Print out of CTC web page showing the granting of my Certificate be (must valid throughout and at the time you apply for your credential). program A copy of my Emergency 30- Day Substitute Permit or printout from the CTC web page showing my permit as granted (must be valid throughout program and at the time you apply for your credential). In Progress - I have applied on -line for a Certificate of Clearance directly to the CTC or have applied for an Emergency Permit at the County Office of Education. I have attached a confirmation page from the on -line CTC application (or County Office) as proof of submission. I understand that I will not be admitted to the program clearance. granting without the of this PROFESSIONAL below) 5. box (Initial INSURANCE LIABILITY ur well -being and rights as a professional providing service for children in the public schools of California. Protects yo San Diego State University matriculated students are provided with this insurance. Students can retrieve a copy at the following website. -%201718%20Certificate.pdf) (http://bfa.sdsu.edu/financial/procurement/docs/SAFECLIP%20 or you may request a copy at the Division of Education. 2 materials) required submit and (detach Application with Rev. 11/01/18

7 6. CBEST one box below) SCORES (Initial - I have passed the CBEST. I have attached a photocopy of my full page test results, including scores. ompleted C – I have attempted the CBEST MS plus Writing or other CTC approved basic skills exam. Result s Completed re attached. a - I am taking/have taken the basic skills exam on the following test date: and In Progress am attaching verification of registration. I understand that my application cannot be reviewed without submission of attempted test scores . I accept full responsibility for delivering/faxing/mailing a passing or of my test scores personally to the Division of Education when they are available. photocopy The CBEST exam must be passed by August 2019 in order to enroll in courses. COMPETENCY VERIFICATION OF SUBJECT MATTER (by 7. waiver or exam) (Initial one box below) Waiver: SDSU I have completed/am completing my subject matter competency program - and am attaching at SDSU the signed “Advisor’s Recommendation Form” with the original signature of the Single Subject Credential Advisor. Other University - I have completed/am completing my approved subject matter competency program at another California Institution. I have attached the signed “Subject Matter Competency Verification Form” with of that the signature of the Credential Analyst original university. List university: CSET Exam: CSET required the copies passing of my attaching am and examination Test Completed - I have passed or attempted scores. on In Progress I have taken/am taking the required CSET Test - the following date: and am exams attaching verification of registration. I accept full responsibility for delivering/ faxing/mailing a photocopy of my test scores personally to the Division of Education when available. OFFICIAL COPIES OF TRANSCRIPTS 8. (Initial all that apply) All candidates are responsible for reporting all universities attended, regardless of the amount of that at coursework completed institution, and provide transcripts for each school. one SDSU ONLY attended San Diego State University as listed below. I am attaching I have unofficial - transcript San Diego State from with this application. All applicants must provide official transcripts University (in sealed envelopes) issued within the last year, from all U.S. colleges and universities attended. Official transcripts should be sent to: Graduate Admissions Office San Diego State Univer sity 5500 Campanile Drive San Diego, CA 92182 -7416 Other Colleges as listed I have attended colleges and universities other than SDSU or in addition to SDSU - transcripts have been reviewed received by until official all below. I understand that my application will not be the Graduate Admission’s Office. 3 materials) required submit and (detach Application with Rev. 11/01/18

8 TRANSCRIPT DATE REQUESTED LIST ALL COLLEGES/UNIVERSITIES ATTACHED LOCATION (City, State) ATTENDED (if not (Initial to confirm) attached) GP 9. (Initial one box ADMISSION A FOR PROGRAM below) Meets GPA Min. - My overall grade point average is at least 2.67 based on all baccalaureate and post - last 60 units attempted. It meets the quarter semester/90 baccalaureate units in the 2.75 or at least attempted Program. criterio n for admission minimum Division of Education to the My overall grade point average is below the minimum GPA for admission to the Division of Below GPA Min. - for Special Consideration for Deficiency in Grade Point Education Program. I am attaching a completed “Petition Average” (see supplemental information). I understand that completing the petition in no way guarantees admission to the program. box below) GOALS (Initial 10. PROFESSIONAL ESSAY I am attaching my typed professional goals essay. I have typed my name in the upper right corner of each together. professional goals essay includes discussion pages you have of why narrative page, My stapling the as a future education chosen profession. OF RECOMMENDATION ( Initial box below) TWO SIGNED LETTERS 11. letterhead stationery. If the letters are not on letterhead, the name, address, and phone Both letters should be on carried and do not need to be number of the sender must be typed on the letter. Letters may be hand- be Concern” or to the “Division of Education.” Letters confidential. may it May addressed to “Whom I am attaching one signed letter of recommendation/reference by an individual who knows me well (but not related to me by blood or marriage) and who can comment directly on factors such as my qualifications for a e, in multicultural teaching/supervising experienc my my work/educational experience, settings, career teaching m success as a teacher. for potential character, y personal or my I am attaching one signed letter of recommendation/reference by a faculty/university professor in my subject institution who knows me well (but not related to me by blood or marriage) and major from my degree- granting on factors as work done under their directio n, my general special abilities, spirit who can comment directly such of leadership. and of cooperation, qualities 4 required with submit and (detach Application materials) Rev. 11/01/18

9 12. -REQUISITE – Approved Health Course: Must be completed within 7 PREREQUISITE/CO COURSE below) entrance be of program of “Credit, C or better”. (Initial one box and years a grade COURSE NUMBER/TITLE TERM/YEAR UNIVERSITY/COLLEGE for a “Request not a recognized equivalent by the Division of Education, I am submitting for approval is If this course Requirements” form with Adjustment course description or syllabus. of Credential a detailed at SDSU have completed the prerequisite/co -requisite approved health course Completed or an equivalent - I course at another university. In Progress - attaching verification of current enrollment in the prerequisite/co -requisite approved health I am course at SDSU or an approved equivalent course at another institution. I will provide an official transcript prior SDSU) to prove completion of the course (unofficial to the start of the credential program. from Future Enrollment- I plan to enroll in this course on: Term Year entrance 13. COURSE – ED 451 : Must be completed within 7 years of program PREREQUISITE and be a grade of “Credit, C or better”. (Initial one box below) ED 451 UNIVERSITY COURSE NUMBER/TITLE TERM/YEAR course for a recognized If this a “Request is not approval equivalent by the Division of Education, I am submitting for Adjustment of Credential with a detailed course description or syllabus. Requirements” form or an completed I have course ED 451 at SDSU the equivalent course at another Completed - prerequisite university. - I am attaching verification of current enrollment in ED 451 at SDSU or an approved equivalent In Progress completion at another course provide an official transcript (unofficial from SDSU) to prove institution. of I will the course prior to the start of the credential program. Future Enrollment- I plan to enroll in this course on: Term Year COURSE 14. PREREQUISITE – TE 303: Must be completed within 7 years of program entrance and be a grade of “Credit, C or better”. (Initial one box below) TE 303 UNIVERSITY COURSE NUMBER/TITLE TERM/YEAR If this course is not a recognized equivalent by the Division of Education, I am submitting for approval a “Request for Adjustment Requirements” form with a detailed course description or syllabus. of Credential Completed - I have completed the prerequisite course TE 303 at SDSU. In Progress - I am attaching verification of current enrollment in TE 303 at SDSU or an app roved equivalent of to prove completion course at another institution. I will provide an official transcript (unofficial from SDSU) credential of the start to the prior course the program. 5 materials) required submit and (detach Application with Rev. 11/01/18

10 Term Yea r Future Enrollment- n to enroll in this course on: I pla REQUIREMENT (Initial one box below) 15. U.S. CONSTITUTION – Completed I am a California State University (CSU) graduate. Completed - I have met the U.S. Constitution requirement by taking the course listed below. COURSE NUMBER / TITLE TERM/YEAR UNIVERSITY t completed - I have not yet met the U.S. Constitution requirement. I understand that I must fulfill this No requirement prior to the completion of the Teacher Preparation Program and the issuance of a teaching credential. For SB2042 EL Credential, I have met (Initial Foreign Language Requirement 16. one box below) the Completed - I have completed five semester units of foreign language. Verification via official transcript(s) is attached. (See Credential Analyst for approved options). Not completed - I have not yet met the foreign language requirement. I understand that I must fulfill this requirement prior to student teaching . 17. CPR REQUIREMENT (Initial one box below) I have mpleted - I have attached CPR training program that covers infant, child, and adult skills. completed a Co agency. a photocopy of my CPR card (both sides) issued by the training I have prior requirement this fulfill Not completed - I must not yet met the CPR requirement. I understand that to award of credential. 18. APPLICATION PROCESSING FEE (Initial one box below) Fee or receipt attached - I am attaching the Application Fee Memorandum and a personal check, cashier’s check or money o rder for $25.00 payable to SDSU with this application. Or I have paid the fee online and attaching a receipt. of $25.00 Paid at Cashiers - I have submitted my application -processing fee directly y to the SDSU Universit Fee Memorandum attaching the stamped Application am office. I to my application as evidence of ashier’s C payment. APPLICATION TO 19. THE UNIVERSITY (Initial one box below) m currently a SDSU student of post-b accalaureate or graduate Current SDSU Graduate Student - I verify that I a semester. standing. I am eligible for enrollment as a continuing student for next accalaureate Application for admission to San submitted a separate Graduate/Post-b I have New Applicant - ine confirmation page showing Diego State University for next semester. I have attached a printout of the on-l for the Spring. llowed that my university application has been submitted. No new applicants are a Confirmation #: 6 Application (detach and submit with required materials) 01 Rev. 11/ /18

11 P LEASE PHOTOCOPY YOUR ENTIRE APPLICATION PACKET FOR YOUR RECORDS. Materials submitted for purposes of admission and enrollment in a credential program become the property of the Family Division of Education. Under the Federal cannot Educational Rights and Privacy Act, the Division of Education your copies or make have you once file from return any application materials (unless you should decide not to attend) Completion of the application materials with the corresponding stipulated been admitted to the program. requirements is a minimum criterion and does not ensure admission. Factors such as professional judgment of the Admissions and Retention Committee and date by which admission requirements are fully met may determine process. admission. An analytical essay and an oral interview are required of the as part I certify I have and understand this entire packet. read that all statements, transcripts, and other information with correct. submitted application true are and this X Date Signature 7 materials) required submit and (detach Application with Rev. 11/01/18

12 SAN DIEGO STATE UNIVERSITY DIVISION OF EDUCATION APPLICATION PROCESSING FEE MEMORANDUM Memorandum To: All Candidates for Credential Programs Credentials/Advising Office, West Faculty 179 From: RE: Credential Program Application Processing Fee fee he Division of Education charges a $25.00 non- refundable payment to file a program application. The following T methods are available. On Line Payment: • Go at www.sdsu.edu/sfs Student Financial Services Web Site to the information. • Select Student Account Services and Log in to your account using your WebPortal login the menu the • Select Make Payment (at select top card, bar) if paying by Electronic Check. If paying by credit credit card option) • Select SDSU Imperial Valley Menu and pay the fee or email • Print out the receipt of Credential and submit it with your packet materials Program Application Payment in person: If you are paying in person, fill out this document and attach a personal check, and submit it with your application. Credential Program Application Fee Payment Payment should be made payable to San Diego State University IV Date: San Diego State University Imperial Valley Number: Phone Attn: Division of Education 720 Heber Ave Student Name: Calexico CA 92231 Number: Student ID 8 Supplemental Form Rev. 11/01/18

13 DIVISION OF EDUCATION SUBJECT MATTER COMPETENCY VERIFICATION FORM used only by candidates who have completed be completing an approved Single Subject teaching major To or are at another institution. California Please note that this must be signed by an approved Credential Analyst. : Analyst TO Credential California Institution of Higher Education FROM: Barbara Layaye, Division Chair RE: PRINT SOCIAL SECURITY NUMBER NAME The above named individual is applying to the Single Subject Teacher Credential Program at San Diego State University/Imperial Valley. In order to complete evaluation of this candidate’s admissions eligibility, we need official verification that he/she has completed a degree program or its equivalent at your institution that has been approved for subject matter competency in lieu of the CSET examinations. I would like to request that, if this candidate has completed of her/his or is in the term of program completion, appropriate verification final subject matter competence be verified by Section the signature of the individual “authorized to recommend” as reflected in the current CTC Handbook, IX-B- 13a- g. The candidate for submission of appropriate transcript copies, if required by you, for this request. is responsible Thank you for your assistance. ---------------------------------------------------------------------------------------------------------------------------------------------------------- my signature, I certify that RED ID By competency complete required Did for a CTC approved subject matter the program at this university. coursework CTC Approved Subject Area: Will be completing coursework for a CTC approved subject matter program at this university during the current academic term. CTC Approved Subject Area: Current academic term and year: Outstanding Coursework: Signature Date Printed name and title Name of California teacher- training institution analyst signature Credential 9 Supplemental Form Rev. 11/01/18

14 San tate U Diego S niversity/Imperial Valley Division of Education Program Professional Goals Essay education as a future Please write about your professional goals. In general, tell why you have chosen as specific Be profession. you to as you can, indicating why you feel that the goals will have chosen to pursue are important and how they assist you grow as an individual TYPED) . (MUST BE 10 Supplemental Form Rev. 11/01/18

15 San Diego State Valley University/Imperial Division of Education Program 720 Heber Avenue, Calexico, CA 92231 Letter of Recommendation (Those with Knowledge of Candidates Skills & Commitment to the Teaching Profession) T o Person submitting this letter: Division is intended for use by the of Education Recommendation Admission and Retention Committee only. Students to make should receive a copy unless you wish not it available to them. Submit in a sealed envelope. C _ andidate ’ s Name: is seeking admission The candidate listed -Imperial University to the Teacher Education Program at San Diego State Valley Campus. Would please help us to evaluate this candidate by preparing a letter of recommendation? you Suggested topics to address include: length of acquaintance, work done under your direction, general special abilities, spirit of cooperation, and qualities of leadership. Also, please discuss any topics not listed that you feel are pertinent. Signature: Affiliation: Phone: Name: Date: _ 11 Supplemental Form Rev. 11/01/18

16 San Diego State Valley University/Imperial Division of Education Program 720 Heber Avenue, Calexico, CA 92231 Letter of Recommendation (University Professor in Students Subject Major) T o Person submitting this letter: Division is intended for use by the of Education Recommendation Admission and Retention Committee only. Students wish should receive a copy unless you not to make it available to them. Submit in a sealed envelope. _ Candidate ’ s Name: The - Imperial University candidate listed is seeking admission to the Division of Education Program at San Diego State by Valley. you please help us to evaluate this candidate Would preparing a letter of recommendation? Suggested acquaintance, work done under your direction, general special topics to address include: length of abilities, spirit of listed cooperation, of leadership. Also, please discuss any topics not and qualities that you feel are pertinent. Signature: Affiliation: Phone: Name: Date: _ 12 Supplemental Form Rev. 11/01/18

17 VISION OF EDUCATION DI SPECIAL OF DEFICIENT GRADE POINT AVERAGE PETITION CONSIDERATION FOR FOR ADMISSION CREDENTIAL PROGRAM (to be submitted with Division of Education Application) In order to be admitted to a Division of Education credential program, the candidate must have a grade point average of at least 2.67 in all baccalaureate and post -baccalaureate course work or a grade point average of at least 2.75 in the last 60 semester or 90 quarter units attempted. above know that you do not If you either of the or believe conditions, please use the space below or a separate page meet to present those factors that may have contributed to the earned deficiency and those factors that you believe mitigate this deficiency. Attach documents that you believe will support the granting of an exception. be Executive limits the number of exceptions that can 758 made at SDSU. The Division of Education Admissions Order and Retention Committee will consider petitions for program admission. Name RED ID For Office Use Only University granting bachelor’s degree units quarter GPA Cumulative GPA Last 60 semester 90 13 Supplemental Form Rev. 11/01/18

18 APPLICATION SUPPLEMENTAL INFORMATION FOR COMPLETING ETHNIC REPORTING CODES Gender, Date of Birth, and Ethnicity: This information is optional and is used for statistical reporting purposes. Ethnic codes currently in use in the form on the application identify the appropriate code on the sheet and write it in the area provided CSU system are provided for your reference. Please itself. Code Ethnic Group AMERICAN INDIAN OR ALASKAN NATIVE: All 1 having origins in any of the original people of North America, and who maintain persons identification through tribal affiliation or community recognition cultural AFRICAN AMERICAN (not of Hispanic origin), including BLACK: All persons having origins in any of the black racial groups of Africa 2 those (except of Hispanic origin) original (not origin) : All persons having origins WHITE of the of Hispanic people of Europe, North America, North Africa, or the 7 in any East (except those of Hispanic origin) Middle LATINO MEXICAN -AMERICAN, MEXICAN, CHICANO: All persons 3 origins in any of the original peoples of Mexico having CENTRAL AMERICAN: All persons having origins in any of the original people of Central America A B SOUTH All persons having origins in any of the original people of South America AMERICAN: CUBAN: of the persons having origins in any Q original people of Cuba All of the PUERTO All persons having origins in any P original people of Puerto Rico RICAN: 4 OTHER LATINO/SPANISH -ORIGIN/HISPANIC: All other persons having origins in any of the original people of the Caribbean Islands, or other persons of Spanish or Latino origin, and not included in the above categories of Mexican, Central American, South Ameri can, Cuban, Puerto and Rican ASIAN AMERICAN CHINESE: All persons C origins in any of the original people of China J having JAPA NESE: All persons having origins in any of the original people of Japan in any K All persons having origins KOREAN: of the original people of Korea INDIAN: R ASIAN Asia All persons having origins in any of the original people of the Indian Subcontinent and Southwest 5 ASIAN: All persons having origins in any of the original people of Asia not included in the above Asian categories OTHER SOUTHEAST ASIAN AMERICAN LAOTIAN: All persons having origins in any of the original L of Laos people M CAMBODIAN: All persons having origins in any of the original people of Cambodia S OTHER SOUTHEAST ASIAN: All persons having origins in any of the original people of Southeast Asia, excluding the Cambodian, Laotian, Vietnamese, or Thai groups ethnic in any All persons T origins THAI: of the original people of Thailand having V VIETNAMESE: All persons having origins in any of the original people of Vietnam PACIFIC ISLANDER F FILIPINO: All persons having origins in any of the original people of the Philippine Islands G GUAMANIAN: All persons having origins in any of the original people of Guam H HAWAIIAN: All persons having origins in any of the original people of Hawaii original All having origins SAMOAN: of the persons people of Samoa N in any OTHER PACIFIC ISLANDER: A ll persons having origins in any of the original people of the Pacific Islands, including Tahiti, Fiji, and the 6 in any Islands, and not included Samoan of the above categories of Guamanian, Hawaiian, and Marshall fall 8 All persons who do not OTHER: into one of the above categories 9 NO RESPONSE: Respondents not surveyed or who do not mark a choice of codes from the list provided. 10 DECLINE TO STATE: All persons who overtly decline to identify themselves with any ethnic category. 14 Supplemental Form Rev. 11/01/18

19 Excerpts from the Education Code 45. Commission may deny any application for the issuance of a credential or for the renewal of a credential made by any 443 The who: applicant the qualifications, which are prescribed by law or regulations, adopted by the Commission pursuant thereto; Lacks (a) by or mentally as to be rendered unfit to perform the duties authorized so disabled the credential for which he or (b) Is physically applies; provided, however, that the mere fact that an applicant has sought or received psychiatric treatment shall not she be considered as preliminary evidence of mental disability and shall not provoke special scrutiny of such applicant’s for a credential; qualifications to the Is addicted beverages to excess; use (c) of intoxicating to the of narcotics or habit-forming drugs; Is addicted (d) use (e) any act involving moral turpitude; Has committed Has had a certification document revoked: (f) Has intentionally practiced or attempted (g) any material deception or fraud in his or her application; to practice (h) or refuses to furnish reasonable evidence of identification or good moral character; or Fails 314 Has (i) of any offense defined in subdivision 1 of Section been or the Penal Code prior to September 7, 1955. convicted Any denial pursuant to subdivisions (a) to (e), inclusive shall be based upon reasons related to the applicant’s fitness to teach or fitness to perform other duties for which that applicant is certificated, or competence to perform the duties, which the credential would the applicant authorize to perform. 46. grounds for denial. 443 Further The Commission shall deny any application for the issuance of a credential or for the renewal of a credential made (a) any by applicant comes within any of the following classes: who Has been determined to be a sexual psychopath under the provisions of Article 1 (commencing with Section 6300), (1) 2, Part 2, Division 6 of the Welfare and Institutions Chapter or under similar provisions of law of any other state. Code (2) Has been convicted of any sex offense as defined in Section 44010. (3) Has convicted of a narcotics offense as defined in Section 44011. been a credential Notwithstanding (2) and (3) of subdivision (a), (b) person shall be denied paragraphs solely on the basis that he no has been convicted of a crime specified in paragraphs (2) and (3) of subdivision (a), if he has obtained a certificate of rehabilitation under Section 4852.01 and following of the Penal Code, and if his probation has been terminated and the information or accusation has been dismissed pursuant to Section 1203.4 of the Penal Code. 10. 45123 “Sex offense” as used in Sections 44346, 44425, 44836, and means any one or more of the offenses listed below: 440 286, (a) Any offense defined in sections 266, 267, 285, 647a, 288, 288a, subdivision 3 or 4 of Section 261, or subdivision (a) or (d) of Section 647 Penal Code. of the Any (b) in former subdivision 5 of former Section 647 of the Penal Code repealed by Chapter 560 of the Statutes of offense defined the 1961, or any offense defined in former subdivision 2 of former Section 311 of the Penal Code repealed by Chapter 2147 of Statutes offense defined in such sections was committed prior to September 15, 1961, to the same extent that such if the of 1961 purposes committed to such date was a sex offense for the prior of this section prior to September 15, 1961. an offense 15, ny offense defined in Section 314 of the Penal Code committed on or after September 1961. A (c) of the Any in former subdivision 1 of former Section 311 of the Penal Code repealed by Chapter 2147 defined Statutes (d) offense committed or after September 7, 1955, and on to September 15, 1961. of 1961 prior Any offense involving lewd and lascivious (e) under Section 272 of the Penal Code committed on or after September 15, conduct 1961. Any offense involving lewd and lascivious conduct under former Section 702 of the Welfare and Institutions Code repealed by (f) tember 15, 1961, to the same extent that such an Chapter 1616 of the Statutes of 1961 if such offense was committed prior to Sep committed prior to such date was a sex offense for the purposes of this section prior to September 15, 1961. offense (g) Any offense defined in Section 286 or 288a of the Penal Code prior to the effective date of the amendment of either section enacted at the Regular Session of the Legislature committed prior to the effective date of the amendment. 1975 -76 attempt -mentioned any of the above Any offenses. (h) to commit or attempted offense or attempted Any other state, which, if committed committed in this state, would have been (i) in any as one or more of the above -mentioned offenses. punishable 440 offenses: “Narcotics offense” as used in Sections 44346, 44425, 44836, and 45123 means any one or more of the following 11. 11368, offense in Sections 11350 to 11355, inclusive, 11366, ny and 11550 of the Health and Safety Code. (a) A the (b) committed or attempted in any other state or against offense laws of the United States which, if committed or Any attempted in this state, would have been punished as one or more of the above -mentioned offenses. inclusive, (c) offense committed under former Sections 11500 to 11503, Any 11557, 11715, and 11721 of the Health and Safety Code. above of the any offenses. -mentioned (d) Any attempt to commit 15 Supplemental Form Rev. 11/01/18

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