Nc Credential Application Form - Division Of Child Development (Page 2 of 2) in pdf

NC Credential Application for NCECC, NCFCCC and NCSACCC cont.

Please read these instructions carefully. (Keep this page for your reference.)

Incomplete forms may be returned and will delay processing.

YOU MUST ANSWER ALL QUESTIONS AND COMPLETE ALL SECTIONS OF THIS FORM to be considered for the credential

certificate. Please print clearly or type your answers. If a question does not apply to you, write N/A (''Not Applicable'') in the space.

Complete Section A–Applicant Information

Complete Section B–Facility Employment Information

Note: Students completing any credential coursework after 12/31/2008 who are not also on a T.E.A.C.H.

scholarship will not receive a bonus award.

Complete Section C–Educational Background

this is a required field

High School Information (

): Check one. To qualify for any of the credential certificates, the

applicant must have a High School Diploma, Adult High School Diploma or GED. Please know that DCD may request proof

of high school diploma or GED at anytime.

College: Check all that have been completed. Attach official transcripts for ALL completed, college coursework and

certificates, diplomas and degrees awarded from an accredited* college/university. We must receive official transcripts.

We will not accept copies, grade reports/copies of grade reports, student copies or Internet printouts of courses/grades.

*Accredited is defined as: has nationally recognized regional accreditation of institutions of higher education by one of the six

regional accrediting agencies. (For institutions of higher education outside of the United States, the recognized system of the

specified country’s accreditation process will be accepted).

Complete Section D–Course Information

Credential Certificates:

NC Early Childhood Credential (NCECC) = EDU 111 and EDU 112 OR EDU 119

NC Family Child Care Credential (NCFCCC) = EDU 111 and EDU 113 OR EDU 113 and EDU 119

NC School Age Child Care Credential (NCSACCC) = EDU 145 and EDU 235 OR EDU 145 and EDU 263

Credential Course Names:

EDU 111—Early Childhood Credential I, EDU 112—Early Childhood Credential II, EDU 113—Family Early Child Credential,

EDU 119—Introduction to Early Childhood Education, EDU 145—Child Development II,

EDU 235—School-Age Development & Program, EDU 263—Development of School Age Program

1. Instructor’s Name or Signature: Provide name of course instructor.

If a course was completed before March 1, 2001

the actual instructor or Early Childhood Department Chair must sign this form and fill in the appropriate boxes.

2. Name of NC Community College Where Coursework Completed: Provide name of NC community college where you

enrolled in the course, not name of facility or building where course was class was held.

3. Date of Enrollment: Provide date of first class you attended for this course. Example: 01/15/02 NOT Spring 2002

4. Date Completed Course: Provide date of last class you attended for this course. Example: 12/15/02 NOT Fall 2002

If you completed the course before July 1, 1999,

5. # of Hrs. Absent:

the number of hours missed must be provided by

the instructor or department chair.

6. Grade: Attach official NC community college transcripts to the form to verify course grades

NOTE:

•

To qualify for the NCSACCC, you must have completed EDU 145 and EDU 235 or EDU 263 after March, 1999.

•

All courses (EDU 111, EDU 112, EDU 119, EDU 113, EDU 145, EDU 235, and/or EDU 263) must be completed at a NC

Community College with a grade of C or better to qualify for a credential certificate.

•

Grade PE (Credit Received), CE (Credit by Exam) or EL (Experiential Learning) disqualifies you from receiving the credential

certificate.

Mail to:

Questions?

Email:

Division of Child Development

Call the Workforce Education Unit

webmasterdcd@ncmail.net

Workforce Education Unit

919-662-4567 or 1-800-859-0829

2201 Mail Service Center

Raleigh, NC 27699-2201

North Carolina Division of Child Development REV 4/09

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DCD 0168

Nc Credential Application Form - Division Of Child Development Page 2

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