Employer Applications, Forms, and Leaflets

This page contains forms that are designed for submission by employing agencies, county offices of education, and colleges/universities. For public leaflets please visit Applications, Forms, and Leaflets page

Leaflet NameLeaflet NumberLeaflet Topic
Credential Application Web Form41-4Application forms and Fingerprint material
Credential Application Form (Spanish)41-4SApplication forms and Fingerprint material
Verification of Basic Skills Requirements41-BSRBasic Skills
Certificate of Completion of Staff Development Recommendation Form41-CCSDEnglish Learner and Bilingual
Child Development Permits -Assistant, Associate, Teacher or Master Teacher ONLY Verification of Completion Form41-CDP1Child Development
Child Development Permits -Site Supervisor or Program Director ONLY Verification of Completion Form41-CDP2Child Development
Child Development Approved-Program Verification Form41-CDP4Child Development Permit
Teacher Induction - Verification of Completion Form41-INDUCTIONInduction
Live Scan Service Request Form41-LSApplication forms and Fingerprint material
Declaration of Change to Name or Personal Profile41-NCApplication forms and Fingerprint material
Recommendation Form for Prelingually Deaf Candidates41-PDApplication forms and Fingerprint material
Services or other Ryan IHE Recommend Form41-RECIHE and Placement Information
SB 2042 Multiple and Single Subject Only --IHE Recommend Form41-REC 2042IHE and Placement Information
IHE Recommend Form for Administrative Credential Programs41-REC ADMINIHE and Placement Information
Request to Revoke or Reinstate41-RRMiscellaneous Materials
Recommendation Form-Special Education41-SPEDIHE and Placement Information
Extensions by Appeal for Teaching and Service Credentials and PermitsAL-3Extensions and Commission Appeals
Service Rendered Without a Valid Credential -Request for ApprovalCL-224Miscellaneous Materials
Eminence Recommendation FormCL-226Eminence-Exchange-Sojourn
Fingerprints Clearance InformationCL-271Application forms and Fingerprint material
School Nurse Services CredentialCL-380School Nurse
University Internship CredentialsCL-402aIntern Credentials District Intern and University Intern
Crosscultural, Language, and Academic Development (CLAD) Permit or Bilingual Authorization Emergency Permit Emergency Renewal Verification FormCL-469 CLAD-BLTeaching and Emergency Permits
Teacher Librarian Services Emergency Permit Renewal Verification FormCL-469 RSP-LIBTeaching and Emergency Permits
Special Education Limited Assignment Permit Renewal Verification FormCL-469 SELAPLimited Assignment
Renewal and Reissuance of CredentialsCL-494Miscellaneous Materials
Declaration of Need For Fully Qualified EducatorsCL-500Miscellaneous Materials
Exchange CredentialCL-501Eminence-Exchange-Sojourn
Exchange Certificated Employee Credential Verification of Information to Accompany ApplicationsCL-502Eminence-Exchange-Sojourn
Eminence CredentialCL-504Eminence-Exchange-Sojourn
30 Day Substitute Annual Statement of NeedCL-505aSubstitute Permits
Career Substitute Emergency Teaching PermitCL-505bSubstitute Permits
Verification of Requirements for the Emergency Career Substitute Teaching PermitCL-505cSubstitute Permits
Prospective Teachers Emergency Substitute Teaching PermitCL-505dSubstitute Permits
30-Day Substitute Emergency Teaching PermitCL-505PSubstitute Permits
Specialist Instruction CredentialsCL-529Specialist Instruction Credentials
CL-533o has been replaced by CL-533o-CLAD-BLCL-533o
Teacher Librarian Services Permit - EmergencyCL-533o-LIBTeaching and Emergency Permits
Resource Specialist Permit - EmergencyCL-533o-RSPTeaching and Emergency Permits
Peace Corps Teaching Experience to Obtain a Multiple or Single Subject Teaching CredentialCL-535Single and Multiple Subject Credentials
Reading and Literacy Leadership Specialist CredentialCL-537Specialist Instruction Including Reading Certificate
Single Subject Teaching Credential Requirements for Teachers Prepared Outside of CaliforniaCL-560Single and Multiple Subject Credentials
Single Subject Teaching Credential Requirements for Teachers Prepared in CaliforniaCL-560CSingle and Multiple Subject Credentials
Multiple Subject Teaching Credential Requirements for Teachers Prepared Outside of CaliforniaCL-561Single and Multiple Subject Credentials
Multiple Subject Teaching Credential Requirements for Teachers Prepared in CaliforniaCL-561CSingle and Multiple Subject Credentials
Teacher Librarian Services CredentialCL-562Library Media Services
Sojourn Certificated Employee CredentialCL-568Eminence-Exchange-Sojourn
Sojourn Certificated Employee Credential - Form for converting Sojourn Certificated Employee Credential to a 5-year Preliminary CredentialCL-568AEminence-Exchange-Sojourn
Sojourn Certificated Employee Credential - Form for individuals who have already completed the appropriate teacher training programCL-568BEminence-Exchange-Sojourn
Administrative Services Credential Out -of-State PreparedCL-574Administrative Services
Administrative Services Credential California PreparedCL-574CAdministrative Services
Supplementary Authorizations (Single Subjects)CL-603Supplementary Authorizations, Subject Matter Authorizations and Added Authorizations
Pupil Personnel Services Credential For Individuals Prepared In Another StateCL-606Pupil Personnel Services Credential
Pupil Personnel Services Credential For Individuals Prepared In CaliforniaCL-606CPupil Personnel Services Credential
Clinical or Rehabilitative Services Credentials (Audiology, Orientation and Mobility)CL-610Speech Language Pathology and Clinical or Rehabilitative Services Credential
Adding a Teaching or Subject Area to General or Standard Teaching CredentialsCL-621Supplementary Authorizations, Subject Matter Authorizations and Added Authorizations
Adding a Teaching or Subject Area to Multiple or Single Subject CredentialsCL-621aSupplementary Authorizations, Subject Matter Authorizations and Added Authorizations
Serving English LearnersCL-622English Learner and Bilingual
Adapted Physical EducationCL-623Special Education and Education Specialist including Resource and Adapted PE
Resource Specialist Added AuthorizationCL-625Special Education and Education Specialist including Resource and Adapted PE
Resource Specialist Added Authorization - Employment Statement for PreliminaryCL-625ASpecial Education and Education Specialist including Resource and Adapted PE
State Agency Reference ListCL-627Miscellaneous Materials
Bilingual AuthorizationsCL-628bEnglish Learner and Bilingual
Crosscultural, Language and Academic Development (CLAD) CertificatesCL-628cEnglish Learner and Bilingual
Supplementary Authorizations for Multiple SubjectCL-629Supplementary Authorizations, Subject Matter Authorizations and Added Authorizations
Foreign Transcripts EvaluationCL-635Miscellaneous Materials
Fee InformationCL-659Application forms and Fingerprint material
Institution's Evaluation For Staff Appeal (RGA-16)CL-666Extensions and Commission Appeals
Basic Skills RequirementCL-667Basic Skills
Multiple Subject Teaching Credentials -- Verifying Subject Matter Competence by ExaminationCL-674MExams
Single Subject Teaching Credentials - Verifying Subject Matter Competence by ExaminationCL-674SExams
Designated Subjects Credential RecommendationCL-689Designated Subjects
Career Technical Education Credential Recommendation Form - Add or Transition to New Industry SectorsCL-689aDesignated Subjects
Supplementary Authorization WorksheetCL-696bSupplementary Authorizations, Subject Matter Authorizations and Added Authorizations
CL-697a has been replaced by CL-697bCL-697aDesignated Subjects
Designated Subjects Adult Education Teaching Credentials (Based on AB 1374 - Issued on or after January 1, 2011)CL-697bDesignated Subjects
CL-698a has been replaced by CL-888CL-698aDesignated Subjects
Designated Subjects Special Subjects Teaching CredentialsCL-699Designated Subjects
Designated Subjects Supervision and Coordination CredentialsCL-700Designated Subjects
District Intern Certificate - Governing Board StatementCL-707AIntern Credentials District Intern and University Intern
District Intern CredentialCL-707bIntern Credentials District Intern and University Intern
District Intern Credential - Recommendation Form (Preliminary or Clear)CL-708Intern Credentials District Intern and University Intern
CL-709 has been replaced by CL-708CL-709Intern Credentials District Intern and University Intern
Documents for Service in Special Centers For the Handicapped (Formerly: Development Center Permits)CL-718Special Education and Education Specialist including Resource and Adapted PE
Child Development Permit WorksheetCL-723aChild Development
CL-740 has been replaced by CL-828.CL-740
CL-760 has been replaced by CL-760GECL-760
Commission Appeals For General Education Teaching Credentials (Multiple and Single Subject)CL-760GEExtensions and Commission Appeals
Verification Of Program Completion For General Education Teaching Credentials (Multiple and Single Subject)CL-760GE-COMPExtensions and Commission Appeals
Commission Appeal for Education Specialist Instruction CredentialCL-760SMExtensions and Commission Appeals
Bilingual Teacher Training Programs (BTTP)CL-772English Learner and Bilingual
Administrator Verification of EmploymentCL-777Administrative Services
Designated Subjects Career Technical Education 30-Day Substitute Teaching PermitCL-786Designated Subjects
Designated Subjects Credential Verification of Completion of Level 1 RequirementsCL-787Designated Subjects
Child Development PermitsCL-797Child Development
Education Specialist Instruction Credential Requirements for Teachers Prepared Outside of CaliforniaCL-808Special 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 CredentialsCL-808CSpecial Education and Education Specialist including Resource and Adapted PE
Education Specialist Instruction Credential Requirements for Teachers Prepared in California for the Preliminary and Clear CredentialsCL-808CASpecial Education and Education Specialist including Resource and Adapted PE
Reading and Literacy Added AuthorizationCL-812Specialist Instruction Including Reading Certificate
Examinations for Teacher Certification In CaliforniaCL-818Exams
Certificate of Completion of Staff DevelopmentCL-824English Learner and Bilingual
Child Development Profession Growth Renewal PacketCL-826Child Development
General Education Limited Assignment Teaching PermitCL-828Limited Assignment
Single Subject And Multiple Subject Teaching Credentials -- Requirements For Teachers With Private School ExperienceCL-834Single and Multiple Subject Credentials
Single or Multiple Subject Teaching Credential Worksheet SB 57 Private School ExperienceCL-835Single and Multiple Subject Credentials
Intern Early Completion OptionCL-840Intern Credentials District Intern and University Intern
Subject Matter Authorization WorksheetCL-849Supplementary Authorizations, Subject Matter Authorizations and Added Authorizations
Subject Matter AuthorizationsCL-852Supplementary Authorizations, Subject Matter Authorizations and Added Authorizations
Induction Program - Verification of Unavailability of a Commission-Approved ProgramCL-855Induction
Provisional Internship PermitCL-856Teaching and Emergency Permits
Provisional Internship Permit - Verification of RequirementsCL-857Teaching and Emergency Permits
Short-Term Staff PermitCL-858Teaching and Emergency Permits
Short-Term Staff Permit - Verification of RequirementsCL-859Teaching and Emergency Permits
Multiple Subject Provisional Internship Permit -- Evaluation WorksheetCL-860Teaching and Emergency Permits
Subject Short-Term Staff Permit -- Evaluation Worksheet Multiple SubjectCL-861Teaching and Emergency Permits
Single Subject Provisional Internship Permit -- Evaluation WorksheetCL-862Teaching and Emergency Permits
Short-Term Staff Permit -- Evaluation Worksheet Single SubjectCL-863Teaching and Emergency Permits
Education Specialist Provisional Internship Permit -- Evaluation WorksheetCL-864Teaching and Emergency Permits
Short-Term Staff Permit -- Evaluation Worksheet Education SpecialistCL-865Teaching and Emergency Permits
Provisional Internship Permit (PIP) and Short-Term Staff Permit (STSP) ChecklistCL-866Teaching and Emergency Permits
Change in Credential AnalystCL-868IHE and Placement Information
Change in Authorized Signatory for IHECL-869IHE and Placement Information
Change in Authorized Signatory for Designated Subjects ProgramsCL-869DSIHE and Placement Information
Single Subject Teaching Credential: Requirements For Individuals Prepared Outside Of The United StatesCL-870Single and Multiple Subject Credentials
Multiple Subject Teaching Credential: Requirements For Individuals Prepared Outside Of The United StatesCL-871Single and Multiple Subject Credentials
Education Specialist Instruction Credential -- Requirements for Individuals Prepared Outside of the United StatesCL-872Special Education and Education Specialist including Resource and Adapted PE
Child Development Permit Verification Of Family Child Care AttendanceCL-877Child Development
Child Development Permit Verification of Family Child Care ExperienceCL-878Child Development
Speech-Language Pathology Services CredentialCL-879Speech Language Pathology and Clinical or Rehabilitative Services Credential
CL-880 has been replaced by CL-888CL-880Designated Subjects
Language Assessor Agency -- Verification of Subject Matter Competence by a Commission-Approved Language Assessor AgencyCL-883Exams
Request for a Three-Year Extension For Multiple Subject, Single Subject, and Education Specialist Teaching CredentialsCL-884Extensions and Commission Appeals
Request for a Two-Year Extension For Multiple Subject, Single Subject, and Education Specialist Teaching CredentialsCL-885Extensions and Commission Appeals
Career Technical Education Teaching Credential - Designated Subject Based on SB 1104 - Issued on or after January 1, 2009CL-888Designated Subjects
Special Education Limited Assignment PermitCL-889Limited Assignment
Added Authorizations in Special Education (AASE)CL-890Special Education and Education Specialist including Resource and Adapted PE
Activity Supervisor Clearance CertificateCL-891Activity Supervisor Clearance Certificate
Military ServiceCL-892Military Service
American Indian Languages CredentialCL-893American Indian Languages
American Indian Languages Credential -Recommendation FormCL-894American Indian Languages
Business and Industry Partnership Teacher AuthorizationCL-895Designated Subjects
Add or Change Authorized DesigneesCL-896IHE and Placement Information
Add or Change Authorized SubmittersCL-897IHE and Placement Information
Mathematics Instructional Leadership Specialist Credential (MILS) and Mathematics Instructional Added Authorization (MIAA)CL-898Specialist Instruction Including Reading Certificate
Certificate of ClearanceCL-900Application forms and Fingerprint material
Managing Educator Profile InformationCL-901Application forms and Fingerprint material
The Teaching Permit for Statutory Leave (TPSL)CL-902Teaching and Emergency Permits
Verification of Requirements For the Teaching Permit for Statutory LeaveCL-903Teaching and Emergency Permits
Verification of Requirements for the Special Education Bridge AuthorizationsCL-904Verification of Requirements for the Special Education Bridge Authorizations Form
Verification Form for the Early Childhood Special Education Teaching Performance ExpectationsCL-905Verification Form for the Early Childhood Special Education Teaching Performance Expectations
Verification Form for the Extensive Support Needs Teaching Performance ExpectationsCL-906Verification Form for the Extensive Support Needs Teaching Performance Expectations
Verification Form for the Mild to Moderate Support Needs Teaching Performance ExpectationsCL-907Verification Form for the Mild to Moderate Support Needs Teaching Performance Expectations
Verification of Requirements for the Emergency Transitional Kindergarten (ETK) PermitCL-908Verification of Requirements for the Emergency Transitional Kindergarten (ETK) Permit
Emergency Specialist Teaching Permit in Early Childhood EducationCL-909Emergency Specialist Teaching Permit in Early Childhood Education
Military and Dependent Spouse Teaching and Services Credential MobilityCL-910Military Service
Teacher Performance Assessment Verification FormCL-911Verification Form for Teacher Performance Assessment
PK-3 Early Childhood Credential Requirements for Teachers Prepared in CaliforniaCL-912PK-3 ECE Specialist Instruction Credential
Education Specialist Bridge AuthorizationCL-914Education Specialist Bridge Authorization
Personal and Professional Fitness Explanation FormOA-EFApplication forms and Fingerprint material
PROGRAM SPONSOR VARIABLE TERM WAIVER REQUESTPS-VTWRWaiver Applications and Forms
Multiple Subject Waiver Evaluation WorksheetWV-MSWaiver Applications and Forms
Education Specialist Waiver Evaluation WorksheetWV-SPEDWaiver Applications and Forms
Single Subject Waiver Evaluation WorksheetWV-SSWaiver Applications and Forms
Waiver ApplicationWV1Waiver Applications and Forms
Waiver Request30-Day Substitute for CBESTWV1SUBWaiver Applications and Forms

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Commission on Teacher Credentialing
651 Bannon Street
Sacramento, CA 95811