Applications, Forms and Leaflets

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Leaflet Name	Leaflet Number	Leaflet Topic
Credential Application Form	41-4	Application forms and Fingerprint material
Credential Application Form (Spanish)	41-4S	Application forms and Fingerprint material
41-DUP has been discontinued.	41-DUP
Verification of Experience - Discontinued June 2016	41-EXP	Designated Subjects
Live Scan Service Request Form	41-LS	Application forms and Fingerprint material
Declaration of Change to Name or Personal Profile	41-NC	Application forms and Fingerprint material
Recommendation Form for Prelingually Deaf Candidates	41-PD	Application forms and Fingerprint material
Renewal Credential Form - Discontinued	41-REN	Application forms and Fingerprint material
Request to Revoke or Reinstate	41-RR	Miscellaneous Materials
Extensions by Appeal for Teaching and Service Credentials and Permits	AL-3	Extensions and Commission Appeals
Basic Skills Requirement Evaluation Worksheet	CL-130	Basic Skills
Eminence Recommendation Form	CL-226	Eminence-Exchange-Sojourn
Fingerprints Clearance Information	CL-271	Application forms and Fingerprint material
School Nurse Services Credential	CL-380	School Nurse
University Internship Credentials	CL-402a	Intern Credentials District Intern and University Intern
Renewal and Reissuance of Credentials	CL-494	Miscellaneous Materials
Exchange Credential	CL-501	Eminence-Exchange-Sojourn
Exchange Certificated Employee Credential Verification of Information to Accompany Applicationse	CL-502	Eminence-Exchange-Sojourn
Eminence Credential	CL-504	Eminence-Exchange-Sojourn
Career Substitute Emergency Teaching Permit	CL-505b	Substitute Permits
Prospective Teachers Emergency Substitute Teaching Permit	CL-505d	Substitute Permits
30-Day Substitute Emergency Teaching Permit	CL-505P	Substitute Permits
CL-506 has been discontinued	CL-506
Specialist Instruction Credentials	CL-529	Specialist Instruction Credentials
CL-533o has been replaced by CL-533o-CLAD-BL	CL-533o
Crosscultural, Language and Academic Development (CLAD) and Bilingual Authorization Permits - EMERGENCY PERMITS	CL-533O CLAD-BL	Teaching and Emergency Permits
Teacher Librarian Services Permit - Emergency	CL-533o-LIB	Teaching and Emergency Permits
Resource Specialist Permit - Emergency	CL-533o-RSP	Teaching and Emergency Permits
CL-533o-RSP-LIB has been replaced by CL-533o-LIB and CL-533o-RSP	CL-533o-RSP-LIB
Peace Corps Teaching Experience to Obtain a Multiple or Single Subject Teaching Credential	CL-535	Single and Multiple Subject Credentials
Reading and Literacy Leadership Specialist Credential	CL-537	Specialist Instruction Including Reading Certificate
Single Subject Teaching Credential Requirements for Teachers Prepared Outside of California	CL-560	Single and Multiple Subject Credentials
Single Subject Teaching Credential Requirements for Teachers Prepared in California	CL-560C	Single and Multiple Subject Credentials
Multiple Subject Teaching Credential Requirements for Teachers Prepared Outside of California	CL-561	Single and Multiple Subject Credentials
Multiple Subject Teaching Credential Requirements for Teachers Prepared in California	CL-561C	Single and Multiple Subject Credentials
Teacher Librarian Services Credential	CL-562	Library Media Services
Sojourn Certificated Employee Credential	CL-568	Eminence-Exchange-Sojourn
Sojourn Certificated Employee Credential - Form for converting Sojourn Certificated Employee Credential to a 5-year Preliminary Credential	CL-568A	Eminence-Exchange-Sojourn
Sojourn Certificated Employee Credential - Form for individuals who have already completed the appropriate teacher training program	CL-568B	Eminence-Exchange-Sojourn
Administrative Services Credential Out -of-State Prepared	CL-574	Administrative Services
Administrative Services Credential California Prepared	CL-574C	Administrative Services
CL-574s has been discontinued.	CL-574s
CL-575 has been discontinued.	CL-575
Supplementary Authorizations (Single Subjects)	CL-603	Supplementary Authorizations, Subject Matter Authorizations and Added Authorizations
Pupil Personnel Services Credential For Individuals Prepared In Another State	CL-606	Pupil Personnel Services Credential
Pupil Personnel Services Credential For Individuals Prepared In California	CL-606C	Pupil Personnel Services Credential
Clinical or Rehabilitative Services Credentials (Audiology, Orientation and Mobility)	CL-610	Speech Language Pathology and Clinical or Rehabilitative Services Credential
CL-620 has been discontinued.	CL-620
CL-620a has been replaced by CL-888	CL-620a
Adding a Teaching or Subject Area to General or Standard Teaching Credentials	CL-621	Supplementary Authorizations, Subject Matter Authorizations and Added Authorizations
Adding a Teaching or Subject Area to Multiple or Single Subject Credentials	CL-621a	Supplementary Authorizations, Subject Matter Authorizations and Added Authorizations
Serving English Learners	CL-622	English Learner and Bilingual
Adapted Physical Education	CL-623	Special Education and Education Specialist including Resource and Adapted PE
Resource Specialist Added Authorization	CL-625	Special Education and Education Specialist including Resource and Adapted PE
State Agency Reference List	CL-627	Miscellaneous Materials
Bilingual Authorizations	CL-628b	English Learner and Bilingual
Crosscultural, Language and Academic Development (CLAD) Certificates	CL-628c	English Learner and Bilingual
Supplementary Authorizations for Multiple Subject	CL-629	Supplementary Authorizations, Subject Matter Authorizations and Added Authorizations
Foreign Transcripts Evaluation	CL-635	Miscellaneous Materials
Fee Information	CL-659	Application forms and Fingerprint material
Basic Skills Requirement	CL-667	Basic Skills
Multiple Subject Teaching Credentials -- Verifying Subject Matter Competence by Examination	CL-674M	Exams
Single Subject Teaching Credentials - Verifying Subject Matter Competence by Examination	CL-674S	Exams
Supplementary Authorization Worksheet	CL-696b	Supplementary Authorizations, Subject Matter Authorizations and Added Authorizations
CL-697a has been replaced by CL-697b	CL-697a	Designated Subjects
Designated Subjects Adult Education Teaching Credentials (Based on AB 1374 - Issued on or after January 1, 2011)	CL-697b	Designated Subjects
CL-698a has been replaced by CL-888	CL-698a	Designated Subjects
Designated Subjects Special Subjects Teaching Credentials	CL-699	Designated Subjects
Designated Subjects Supervision and Coordination Credentials	CL-700	Designated Subjects
District Intern Credential	CL-707b	Intern Credentials District Intern and University Intern
Documents for Service in Special Centers For the Handicapped (Formerly: Development Center Permits)	CL-718	Special Education and Education Specialist including Resource and Adapted PE
Child Development Permit Worksheet	CL-723a	Child Development
CL-740 has been replaced by CL-828.	CL-740
CL-760 has been replaced by CL-760GE	CL-760
Commission Appeals For General Education Teaching Credentials (Multiple and Single Subject)	CL-760GE	Extensions and Commission Appeals
Verification Of Program Completion For General Education Teaching Credentials (Multiple and Single Subject)	CL-760GE-COMP	Extensions and Commission Appeals
Verification Of Experience For General Education Teaching Credentials (Multiple and Single Subject)	CL-760GE-VOE	Extensions and Commission Appeals
Statement Of Release Of Student Records	CL-760REL	Extensions and Commission Appeals
Commission Appeal for Education Specialist Instruction Credential	CL-760SM	Extensions and Commission Appeals
CL-765 has been replaced by CL-892	CL-765
Bilingual Teacher Training Programs (BTTP)	CL-772	English Learner and Bilingual
Administrator Verification of Employment	CL-777	Administrative Services
Education Specialist - Verification of Employment - Discontinued April 2011	CL-777.1	Special Education and Education Specialist including Resource and Adapted PE
Designated Subjects Career Technical Education 30-Day Substitute Teaching Permit	CL-786	Designated Subjects
Child Development Permits	CL-797	Child Development
Education Specialist Instruction Credential Requirements for Teachers Prepared Outside of California	CL-808	Special Education and Education Specialist including Resource and Adapted PE
Education Specialist Instruction Credential Requirements for Teachers Prepared in California for the Level I and Level II Credentials	CL-808C	Special Education and Education Specialist including Resource and Adapted PE
Education Specialist Instruction Credential Requirements for Teachers Prepared in California for the Preliminary and Clear Credentials	CL-808CA	Special Education and Education Specialist including Resource and Adapted PE
Reading and Literacy Added Authorization	CL-812	Specialist Instruction Including Reading Certificate
Examinations for Teacher Certification In California	CL-818	Exams
CL-820 has been discontinued.	CL-820
150-Clock Hours For Clear Teaching Credentials - Verification of Completion Based on Five Years of Teaching Experience	CL-820a	Single and Multiple Subject Credentials
CL-823VPS has been discontinued.	CL-823VPS
Certificate of Completion of Staff Development	CL-824	English Learner and Bilingual
Child Development Profession Growth Renewal Packet	CL-826	Child Development
General Education Limited Assignment Teaching Permit	CL-828	Limited Assignment
Single Subject And Multiple Subject Teaching Credentials -- Requirements For Teachers With Private School Experience	CL-834	Single and Multiple Subject Credentials
Intern Early Completion Option	CL-840	Intern Credentials District Intern and University Intern
CL-842 has been withdrawn.	CL-842
Subject Matter Authorization Worksheet	CL-849	Supplementary Authorizations, Subject Matter Authorizations and Added Authorizations
Subject Matter Authorizations	CL-852	Supplementary Authorizations, Subject Matter Authorizations and Added Authorizations
Induction Program - Verification of Unavailability of a Commission-Approved Program	CL-855	Induction
Provisional Internship Permit	CL-856	Teaching and Emergency Permits
Short-Term Staff Permit	CL-858	Teaching and Emergency Permits
Multiple Subject Provisional Internship Permit -- Evaluation Worksheet	CL-860	Teaching and Emergency Permits
Subject Short-Term Staff Permit -- Evaluation Worksheet Multiple Subject	CL-861	Teaching and Emergency Permits
Single Subject Provisional Internship Permit -- Evaluation Worksheet	CL-862	Teaching and Emergency Permits
Short-Term Staff Permit -- Evaluation Worksheet Single Subject	CL-863	Teaching and Emergency Permits
Education Specialist Provisional Internship Permit -- Evaluation Worksheet	CL-864	Teaching and Emergency Permits
Short-Term Staff Permit -- Evaluation Worksheet Education Specialist	CL-865	Teaching and Emergency Permits
Induction Program Credential Analyst/Contact Person - Discontinued May 2012	CL-866	Induction
Induction Programs -Authorized Signatory Form - Discontinued May 2012	CL-867	Induction
Authorized Organization For Credential/Permit - Discontinued May 2012	CL-867AO	Teaching and Emergency Permits
Single Subject Teaching Credential: Requirements For Individuals Prepared Outside Of The United States	CL-870	Single and Multiple Subject Credentials
Multiple Subject Teaching Credential: Requirements For Individuals Prepared Outside Of The United States	CL-871	Single and Multiple Subject Credentials
Education Specialist Instruction Credential -- Requirements for Individuals Prepared Outside of the United States	CL-872	Special Education and Education Specialist including Resource and Adapted PE
Preliminary Multiple Subject Teaching Credential Worksheet	CL-873	Single and Multiple Subject Credentials
Single Subject Teaching Credential Worksheet	CL-874	Single and Multiple Subject Credentials
Education Specialist Instruction Teaching Credential Worksheet	CL-875	Special Education and Education Specialist including Resource and Adapted PE
Child Development Permit Application Checklist	CL-876	Child Development
Child Development Permit Verification Of Family Child Care Attendance	CL-877	Child Development
Child Development Permit Verification of Family Child Care Experience	CL-878	Child Development
Speech-Language Pathology Services Credential	CL-879	Speech Language Pathology and Clinical or Rehabilitative Services Credential
CL-880 has been replaced by CL-888	CL-880	Designated Subjects
Request for a Three-Year Extension For Multiple Subject, Single Subject, and Education Specialist Teaching Credentials	CL-884	Extensions and Commission Appeals
Request for a Two-Year Extension For Multiple Subject, Single Subject, and Education Specialist Teaching Credentials	CL-885	Extensions and Commission Appeals
Career Technical Education Teaching Credential - Designated Subject Based on SB 1104 - Issued on or after January 1, 2009	CL-888	Designated Subjects
Special Education Limited Assignment Permit	CL-889	Limited Assignment
Added Authorizations in Special Education (AASE)	CL-890	Special Education and Education Specialist including Resource and Adapted PE
Activity Supervisor Clearance Certificate	CL-891	Activity Supervisor Clearance Certificate
Military Service	CL-892	Military Service
American Indian Languages Credential	CL-893	American Indian Languages
Business and Industry Partnership Teacher Authorization	CL-895	Designated Subjects
Mathematics Instructional Leadership Specialist Credential (MILS) and Mathematics Instructional Added Authorization (MIAA)	CL-898	Specialist Instruction Including Reading Certificate
Certificate of Clearance	CL-900	Application forms and Fingerprint material
Managing Educator Profile Information	CL-901	Application forms and Fingerprint material
The Teaching Permit for Statutory Leave (TPSL)	CL-902	Teaching and Emergency Permits
Emergency Specialist Teaching Permit in Early Childhood Education	CL-909	Emergency Specialist Teaching Permit in Early Childhood Education
Personal and Professional Fitness Explanation Form	OA-EF	Application forms and Fingerprint material

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Updated August 09, 2022