Early Educator Certification (Eec) Request Form printable pdf download

Early Educator Certification (EEC) Request Form

The EEC Request Form is required for all requests for reassessment or reprinting of a certificate/card. Please indicate your needs

below and send this form, the applicable fee and supporting documents to NC Institute for Child Development Professionals, Early

Educator Certification, PO Box 959, Chapel Hill, NC 27514.

Date:

Last 4 digits of SSN:

First name:

Middle name:

Last name:

REQUIRED: Complete the back of this form with updated contact and employment information.

❏ Assessment Appeal- No Charge: I believe that EEC assessed my education at the wrong level. I understand that if EEC made an

error based on the transcripts on file, a new certificate and card will be sent to me. My expiration date will not change unless my

new level allows a longer validity period. If I was assessed accurately based on EEC policies, no changes will be made.

❏ Out of Cycle Update or Reprint- $10. Please select the items below that you would like EEC staff to review. The $10 fee will

cover all items selected. Materials Required: Complete the EEC Update Form on the opposite side and include the $10

nonrefundable fee. If additional transcripts should be reviewed, please include them as well.

❏ Reprint: I lost my certificate/card or would like a duplicates printed. I would like my name printed as follows (if blank,

only first and last name will be printed on certificate):

❏

Additional Scale: I have already received certification on one scale and would like EEC to assess my education against

an additional scale. I understand that if I am at a higher level on the scale for my already existing certification, EEC will

print my certificate and card at the higher level. REQUIRED: Current certificate must be six months or greater

from expiration. Please choose one of the following:

❏

I would like both scales to have the same expiration date. I understand that I will have a shorter period of time to

complete renewal requirements for the added scale.

❏

I would like my added scale to have a full renewal cycle of three or five years. I understand that each scale will

have a unique expiration date, but I can choose to renew both at the same time if I have met the renewal

requirements for both.

❏

Update level: My certificate has not yet expired, but I have recently completed coursework that may move me to a

higher level on the certification scale. I would like my education reassessed. I understand that if I am at a higher level,

my certificate and card will be updated to reflect the new level and my certificate expiration date will not change. If I

am not at a higher level, I understand that my fee will not be reimbursed.

❏

Endorsement update: Select from the following:

❏

Professional Development Endorsement (PDE): I have completed my adult learning course and want this reflected

on my certificate. I have enclosed documentation of my adult learning.

❏

Administrator Endorsement- level: I have increased my education and EEC level and believe I qualify at a higher

endorsement level.

❏

Administrator Endorsement- experience: I believe I have reached a higher endorsement level due to my continued

experience in an administrative role. I have indicated my child care administration experience below. (Experience

must be in a child care center and include responsibilities such as hiring, staff evaluation, classroom evaluation,

planning, oversight of rules and regulations and financial management. Experience in a small family child care

home cannot count toward this requirement. A minimum of one year and up to five years of experience should be

documented to ensure you are endorsed at the highest level possible.)

Dates of Employment

Child Care Center Name

Position Title

Transcript Documentation Requirements: Official transcripts or official grade reports are required to document the completion of

coursework. Students attending colleges that offer student access to transcripts online may be able to submit an Internet

Permission Form (IPF) allowing EEC to access your account and download your transcript. Please see more details about the IPF

Payment Requirements: EEC accepts checks or money orders. Credit card payments are not accepted at this time. Make checks

payable to: NC Institute for Child Development Professionals.

To renew your Early Educator Certification, please complete the EEC application and submit documentation of your professional

development.

For more information about Early Educator Certification, please visit our website at All required forms can be

accessed at our website or by calling 919-942-7442.

EEC Request Form

Updated 2/1/2014

Early Educator Certification (Eec) Request Form

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