Application 41-4 Web Form FAQ

If the CDS code is not listed under the School District CDS Code, click on the box “Don’t see your School District?” to be able to type the CDS code for the appropriate school the document is to be restricted to. 

• For a change of restriction on an Intern credential: Under Section 2 select “Change of Restriction”. In Section 3 select “Other” and type “Intern Restriction Change” in the text field. 
• For a reactivation of an Intern credential: Under Section 2 select “Other”. In the “Other” field, type “Intern Reactivation”. Then in Section 3 select the Single Subject, Multiple Subject, or Education Specialist.
• For an extension to an Intern document: Under Section 2 select “Extension by Appeal”. In Section 3 select “Other” and type “Extension to Intern credential” in the text field. 
• Note- Comments may be added on page 5 that indicates the application is for the Intern credential.

The individual will need to complete the 41-4 web form in its entirety, generate the PDF, sign the form, and then provide the completed application to the employer or program to complete the File Date Box. 

Yes, older versions of the 41-4 completed by hand can still be submitted at this time. However, the Commission strongly encourages everyone to utilize the new web form and the tools it provides to reduce errors, speed up processing, and avoid any unnecessary delays with application submission.

An application must be completed by the applicant directly. An employing agency should only complete the file box section of an application as the applicant must sign under penalty of perjury that the application in its entirety is correct.