Jim and Judy Watson COE Student Services
Program Admissions
5500 University Parkway
San Bernardino, CA 92407
http://coe.csusb.edu/studentServices/index.html
Multiple Subject
Program Admissions File (P.A.F.) Requirements
Listed below are the requirements you will need to submit to apply to the Multiple Subject Credential Program.
1. You must complete the online University Application and submit official transcripts from each institution
attended (with the exception of California State University, San Bernardino) to the Graduate Admissions
Office by the deadline for that quarter. Note: These transcripts must have a current date, not to exceed one
year.
2. Program Admissions Application.
3. Admission Interview If you have successfully completed EELB 230, at California State University, San
Bernardino, then this requirement has been met. If not, then you will need to schedule an appointment with
a Multiple Subject Advisor to obtain this form and submit with your Program Admissions File.
4. Personal Narrative – If you have successfully completed EELB 230, at California State University, San
Bernardino, then this requirement has been met. If not, you will need to submit your personal narrative (this
should be no longer than two typewritten, double-spaced pages). Please type your name and My Coyote
number in the upper right hand corner of each page.
5. Two Letters of RecommendationThese letters must be completed on our Letter of Recommendation
forms. Please obtain these letters from someone who is able to address your scholastic performance and
suitability for teaching (a family member cannot complete these letters).
6. Verification of Negative TB Test Results – Submit a copy, must include the following: Your name, agency
where TB test was administered and read, signature from authorized personnel, date the TB test was read
and that you have no presence of TB. Results are valid for four years.
7. Verification of Certificate of Clearance – You must complete the Request for Livescan Service (41-LS)
with a Transmitting Agency, then you will need to follow up with the Commission on Teacher
Credentialing by submitting an application for your Certificate of Clearance.
8. Official Transcripts – You will need to submit an official transcript from each institution attended with the
exception of California State University, San Bernardino. Please note: This is in addition to transcripts you
may have submitted to the University.
9. Verification of 45 Hours in a K-12 Classroom If you completed EELB 230 and HD 245, 246 or 247 or
EELB 301at California State University, San Bernardino then you have met this requirement and we can
verify through your transcripts. If not, you will need to obtain a documented letter from the person(s) who
supervised your work (it must include the number of hours). If you took an equivalent course, but it is not
the ones listed above, you will need to provide documentation of your experiences either through fieldwork
logs or a course syllabus.
10. Pre-Requisite CourseworkYou must successfully complete ENG 311 and EELB 301 or HD 240 in order
to be classified into the Multiple Subject Credential Program.
11. Verification of Subject Matter Competency – You must submit a photocopy along with your official CSET
Score Report verifying that you have passed all three subtests for Multiple Subjects. Your official score
report will be returned to you.
12. Verification of the Basic Skills Requirement – You must submit a photocopy along with your official score
report. Your official score report will be returned to you. (Example: CBEST)
13. GPA – You must have a cumulative GPA of a 2.67 or your last 90 units GPA of a 2.75 in order to be
admitted to the Multiple Subject Credential Program.
14. $35 Program Admissions Filing Fee This fee must be paid either on-line through MyCoyote or in person
at the Bursar Office. Please note, that if you pay this in person at the Bursar Office you will be required to
show them a Fee Receipt.
Additional Requirements for Interns
1. Verification of U.S. Constitution Course – This can be verified through your transcripts and a copy of
the course description if taken outside of California State University, San Bernardino.
2. Pre-Service Coursework – You must successfully complete the following courses:
EELB 301: Growth & Development in Socio-Educational Contexts
Or HD 240: Introduction to Child Development
And
EEB 313: Pedagogical Foundations for English Language Learners
EELB 315/316: Reading Language Arts Curriculum and Pedagogy
EELB 422: Classroom Organization, Management & Discipline
MS PAF REQ REVISED 09/17/13
PROGRAM ADMISSIONS APPLICATION
Student ID #: ______________________________ Applying for (Quarter/Year): ____________________
Name: __________________________________________________ _____________________________
Last, First, Middle Initial Maiden/Former Names
Mailing Address: __________________________________________________________________________
Street, City, State, Zip
Home Phone: ________________________________ Work Phone: ______________________________
Cell Phone: __________________________________ Birthdate: ________________________________
Ethnicity (optional):_____________________________ Gender: _________________________________
Email Address: ___________________________________________________________________________
Please indicate which program you are applying for:
Program: ________________________________________________________________________________
Subject Area (Single Subject only): ___________________________________________________________
Option: _________________________________________________________________________________
Added Authorizations: _____________________________________________________________________
Degree Information:
University where Bachelor’s Degree was/will be granted: __________________________________________
Academic Major: _________________________________________________________________________
Date of degree or anticipated date of completion: ________________________________________________
List of all colleges/universities you have attended: _______________________________________________
________________________________________________________________________________________
My signature below confirms that each of the program requirements for admissions has been completed to the
best of my knowledge.
________________________________________________ ____________________________
Student’s Signature Date
PROG ADM APP REVISED 9/12/13
SELECT ONE
SELECT ONE
SELECT ONE
SELECT ONE
SELECT ONE
!
!
!
LETTER%OF%RECOMMENDATION%
FOR%THE%C REDENTIAL%PR OGRAM%
%
!!!
!
A!brief!explanation !of!the!purpose!of!th is!recomm endation:!! The!person!whose!n ame!appe ars!on!this !form!is!an!applican t!for!a!teaching!credential!program.!!The!College!
of!Educati on!at!Calif ornia!Stat e!University,!San!Be rnardino!is!collectin g!informat ion!about!this!perso n!to!help!us!determ ine:!(1)!if!he/she!has !the!potential!to!develop!
into!a!goo d!teacher!and!(2)!what!we!can!do!to!hel p!him/her !acquire!the!specific!skills!necessary!to!b ecome!a!good!teacher.!!You!ca n!help!us! by!respon ding!to!each!of!the!
items!described!below.!!Pleas e!respond!to!each!item!in!acco rdance!with!your!dir ect!observ ation!of!th e!applicant!relative !to!the!specified!area.!!The!recommendation!is!to!
be!return ed!to!the!applicant!in!a!sealed !envelope .!!We!appreciate!your!assistan ce.!!A!key! for!the!letters!(A,!B,!C!&!D)!is!listed!on!thi s!page.!!!
________________________________________!! !
Name!of!Applicant!! !
! ! !
______________________________!
Applicant’s!Student!ID#!
!
!
!
!
A%
B%
C%
D%
1!
Oral%Communication:!!The!a pplicant!uses!the!language!accurately!a nd!communicates!cl early!and!concisely.!
!
!
!
!
!
2!
Listening%Skill:!!The!applicant!list ens!a ttentively!and!demonstrates!understanding!of!what!he/she!has!heard.!
!
!
!
!
!
3!
Reading%Skill: !!The! applicant !comprehends!written!instructions!and!other!complex!written!information . !
!
!
!
!
!
4!
Writing%Skill:!!The! applicant!writes!in!a!manner! that!is!clear!and!grammatically!cor rect.!
!
!
!
!
!
5!
Empathy:!!The !appl icant!demonstrates!concern!for!people!in!var ious!situations.!
!
!
!
!
!
6!
Organiza tion:!!The!applicant!iden tifies!specific!tasks,!collects!appropriate !informati on!and!generally!functions!in!
a!logical!and!productive! manner.!
!
!
!
!
7!
Time%Management:!!The!applicant!org anizes!time!so!that!t asks!undertaken!are!com pleted!in!accor dance!with!a!
schedule!t hat!he/she!has!predeterm ined!or!agreed!to!accept.!
!
!
!
!
8!
Attendan ce%&%Punctuality:!!The!applicant!c onsistently!kee ps!appoin tmen ts!and!arrives!on!time.!
!
!
!
!
!
9!
Initiative:!!The!app licant!identifies!what!needs!to!be!done!in!situations!and!does!it!promptly.!
!
!
!
!
!
10!
Scho larship:%%The!a pplic ant!analyzes,!synthesizes !and!applies!information!to!th e!solution!of!specific!problems.!
!
!
!
!
!
11!
Persistence:!!The!applicant,!after!having!identified!specific!tasks,!continues!to!pursue!those!ta sks!until!
accomplished.!
!
!
!
!
12!
Lead ership:!!The!applicant!helps!others!to!accom plish!specifically!identified!tasks!throug h!direction!and !example.!
!
!
!
!
!
13!
SelfKConfidence:!!The!applicant!demon strates!faith!in! their! convictions!in!the!face!of!adversity.!
!
!
!
!
!
14!
Willingness%to%Accept%Feedback: !!The!applicant !incorporates!the!suggest ions!of!others!into!the!way!he/she!
functions.!
!
!
!
!
15!
Consistence:!!The!a pplic ant!regularly!d emonstrates!be havior!that!is!appropriate!to!t he!sit uation.!
!
!
!
!
!
16!
Tolerance:!!The!applican t!can!accept!the!views!of! others!and!inte grate !them!with!his/her!own.!
!
!
!
!
!
Please%make%a ny%additional% comment s%you%wish%relative%to%this%indivi dual’ s%potential%for%teaching:%
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________!
A% Sufficient%to%function%a s%a%teacher%
B% Coul d%function%as%a%teacher% with%improve ment%
C% Not%sufficient%to%function%as%a%teacher%
D% No%basis%for%judgment%
EVALUATOR%
_____________________________________! ____________________________________! ____________________________________!
Print!Name! ! ! ! !Sign ature! ! ! ! !Date!
!
_____________________________________! ____________________________________! ____________________________________!
Posit ion! ! ! ! ! !Institution! ! ! ! !Phone!Number!
!
_____________________________________________________________________________________________________________________!
Stree t!Number!&!Na me! ! ! City! ! ! ! ! State! ! ! Zip!
!
!
LTR OF REC REVISED 9/17/13
Jim and Judy Watson COE Student Services (CE-102)
5500 University Parkway
San Bernardino, CA 92407-2393
INSTRUCTIONS FOR PROCESSING A CERTIFICATE OF CLEARANCE
1. Complete the applicable sections of the CTC Request for Livescan Service - 41-LS, which can be
downloaded at their website at http://www.ctc.ca.gov/credentials/applications.html, prior to arriving at the Live
Scan site offering electronic submission of fingerprint services. Applicants may refer to the CSUSB Police
Department website at http://police.csusb.edu/LiveScan.htm for applicable fees and hours of operation or call
(909) 537-3552 to schedule an appointment for Live Scan service. A current listing of other Live Scan sites
offering electronic fingerprint services is available on the California Attorney General’s website at
www.ag.ca.gov or you may contact your local police or sheriff station for Live Scan service availability and
hours of operation.
2. Apply for the Certificate of Clearance using the Web Application Process at the CTC website.
(www.ctc.ca.gov)
IMPORTANT: Before beginning the application process, be sure to turn off all pop-up blockers for this site.
3. Click the Online Services for Educators navigation button.
4. Select the link “Click Here” to complete your application in the Educator Page.
5. Create/log in to your personal profile on the secure Educator Page using your SSN and date of birth. If
creating a new profile, you will need to enter this information twice.
6. Edit/Complete your personal profile and click “Next.”
7. Click on “Create New” button under Web Applications to start your application for the Certificate of
Clearance.
8. Select the Certificate of Clearance from the drop down menus; review the checklist verifying you meet all
requirements for the document, print it, click “Next.”
9. Read the Disclosure page for the Professional Fitness questions and answer “Yes” to continue to the next
page.
10. Answer each of the Professional Fitness Questions, complete the Oath and Affidavit, and click Submit
Payment.
11. The display shows the document applied for and the amount to pay. Click the Continue button.
12. Complete the billing verification information for LexisNexis. Choose to pay with credit card (can also use
debit card with Visa or MasterCard logo). Click Continue button when finished.
13. Verify all the payment information is correct, including email address. Click Complete Payment button.
DO NOT CLICK THE COMPLETE PAYMENT BUTTON MORE THAN ONCE.
14. Use the link provided to obtain a printable receipt for your reference.
NOTE: If you answered “yes” to any of the Personal and Professional Fitness questions you must send
required supporting materials to the Commission as per instructions.
C OF C INSTRUCTIONS REVISED 9/17/13
Jim and Judy Watson COE Student Services
Program Admissions (CE 102)
5500 University Parkway
San Bernardino, CA 92407-2393
http://coe.csusb.edu/forms/index.html
FEE RECEIPT
The CSUSB non-refundable processing fee may be paid using one of the following payment methods or additional
options may be located at the Bursar website at http://admnacct.csusb.edu/bursar.htm.
1. Submit a completed Fee Receipt directly to the Bursar (UH-35) with payment (cash, check, money order,
traveler’s check, cashier’s check or pin based ATM are acceptable). NOTE: The Fee Receipt (stamped by the
Bursar) will need to be submitted to Program Admissions with your Program Admission File.
2. Pay on-line via MyCoyote with an electronic check or credit card (2.9% convenience fee) via American Express,
Discover and Mastercard accepted (Visa is not accepted).
MyCoyote Payment Instructions:
Sign in to your MyCoyote account via the CSUSB home page at http://www.csusb.edu (Coyote ID &
password required)
Select SB Make Payments
Select Pay Fees via eCheck or Credit Card
Select Make Payment
Select Program Admissions File Fee
Select Add to Basket
Select Checkout and make your payment option
NOTE: A copy of the MyCoyote confirmation page and a complete Fee Receipt will need to be submitted with your
Program Admission File.
PERSONAL INFORMATION
Student Identification Number:
Last Name, First Name, M.I.
Address, City, State, Zip
Home Phone:
Work Phone:
Cell Phone:
CSUSB Email Address:
SERVICE FEE
Select the SERVICE for which you are applying:
OFFICE USE ONLY: PS#: 501899-RT011-C0720-5000 QC#: 716 RECEIVED BY:
SELECT ONE
FEE RECEIPT REVISED 9/16/13