Employer Applications, Forms and Leaflets

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Leaflet Name	Leaflet Number	Leaflet Topic
Credential Application Web Form	41-4	Application forms and Fingerprint material
Credential Application Form (Spanish)	41-4S	Application forms and Fingerprint material
Verification of Basic Skills Requirements	41-BSR	Basic Skills
Certificate of Completion of Staff Development Recommendation Form	41-CCSD	English Learner and Bilingual
Child Development Permits -Assistant, Associate, Teacher or Master Teacher ONLY Verification of Completion Form	41-CDP1	Child Development
Child Development Permits -Site Supervisor or Program Director ONLY Verification of Completion Form	41-CDP2	Child Development
Child Development Approved-Program Verification Form	41-CDP4	Child Development Permit
Teacher Induction - Verification of Completion Form	41-INDUCTION	Induction
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
Services or other Ryan IHE Recommend Form	41-REC	IHE and Placement Information
SB 2042 Multiple and Single Subject Only --IHE Recommend Form	41-REC 2042	IHE and Placement Information
IHE Recommend Form for Administrative Credential Programs	41-REC ADMIN	IHE and Placement Information
Recommendation Form-Special Education	41-SPED	IHE and Placement Information
Extensions by Appeal for Teaching and Service Credentials and Permits	AL-3	Extensions and Commission Appeals
Service Rendered Without a Valid Credential -Request for Approval	CL-224	Miscellaneous Materials
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
Crosscultural, Language, and Academic Development (CLAD) Permit or Bilingual Authorization Emergency Permit Emergency Renewal Verification Form	CL-469 CLAD-BL	Teaching and Emergency Permits
Teacher Librarian Services Emergency Permit Renewal Verification Form	CL-469 RSP-LIB	Teaching and Emergency Permits
Special Education Limited Assignment Permit Renewal Verification Form	CL-469 SELAP	Limited Assignment
Renewal and Reissuance of Credentials	CL-494	Miscellaneous Materials
Declaration of Need For Fully Qualified Educators	CL-500	Miscellaneous Materials
Exchange Credential	CL-501	Eminence-Exchange-Sojourn
Exchange Certificated Employee Credential Verification of Information to Accompany Applications	CL-502	Eminence-Exchange-Sojourn
Eminence Credential	CL-504	Eminence-Exchange-Sojourn
30 Day Substitute Annual Statement of Need	CL-505a	Substitute Permits
Career Substitute Emergency Teaching Permit	CL-505b	Substitute Permits
Verification of Requirements for the Emergency Career Substitute Teaching Permit	CL-505c	Substitute Permits
Prospective Teachers Emergency Substitute Teaching Permit	CL-505d	Substitute Permits
30-Day Substitute Emergency Teaching Permit	CL-505P	Substitute Permits
Specialist Instruction Credentials	CL-529	Specialist Instruction Credentials
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
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
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
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
Resource Specialist Added Authorization - Employment Statement for Preliminary	CL-625A	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
Institution's Evaluation For Staff Appeal (RGA-16)	CL-666	Extensions and Commission Appeals
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
Designated Subjects Credential Recommendation	CL-689	Designated Subjects
Career Technical Education Credential Recommendation Form - Add or Transition to New Industry Sectors	CL-689a	Designated Subjects
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 Certificate - Governing Board Statement	CL-707A	Intern Credentials District Intern and University Intern
District Intern Credential	CL-707b	Intern Credentials District Intern and University Intern
District Intern Credential - Recommendation Form (Preliminary or Clear)	CL-708	Intern Credentials District Intern and University Intern
CL-709 has been replaced by CL-708	CL-709	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
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
Commission Appeal for Education Specialist Instruction Credential	CL-760SM	Extensions and Commission Appeals
Bilingual Teacher Training Programs (BTTP)	CL-772	English Learner and Bilingual
Administrator Verification of Employment	CL-777	Administrative Services
Designated Subjects Career Technical Education 30-Day Substitute Teaching Permit	CL-786	Designated Subjects
Designated Subjects Credential Verification of Completion of Level 1 Requirements	CL-787	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	al 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
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
Single or Multiple Subject Teaching Credential Worksheet SB 57 Private School Experience	CL-835	Single and Multiple Subject Credentials
Intern Early Completion Option	CL-840	Intern Credentials District Intern and University Intern
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
Provisional Internship Permit - Verification of Requirements	CL-857	Teaching and Emergency Permits
Short-Term Staff Permit	CL-858	Teaching and Emergency Permits
Short-Term Staff Permit - Verification of Requirements	CL-859	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
Provisional Internship Permit (PIP) and Short-Term Staff Permit (STSP) Checklist	CL-866	Teaching and Emergency Permits
Change in Credential Analyst	CL-868	IHE and Placement Information
Change in Authorized Signatory for IHE	CL-869	IHE and Placement Information
Change in Authorized Signatory for Designated Subjects Programs	CL-869DS	IHE and Placement Information
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
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
Language Assessor Agency -- Verification of Subject Matter Competence by a Commission-Approved Language Assessor Agency	CL-883	Exams
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
American Indian Languages Credential -Recommendation Form	CL-894	American Indian Languages
Business and Industry Partnership Teacher Authorization	CL-895	Designated Subjects
Add or Change Authorized Designees	CL-896	IHE and Placement Information
Add or Change Authorized Submitters	CL-897	IHE and Placement Information
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
Verification of Requirements For the Teaching Permit for Statutory Leave	CL-903	Teaching and Emergency Permits
Verification of Requirements for the Special Education Bridge Authorizations	CL-904	Verification of Requirements for the Special Education Bridge Authorizations Form
Verification Form for the Early Childhood Special Education Teaching Performance Expectations	CL-905	Verification Form for the Early Childhood Special Education Teaching Performance Expectations
Verification Form for the Extensive Support Needs Teaching Performance Expectations	CL-906	Verification Form for the Extensive Support Needs Teaching Performance Expectations
Verification Form for the Mild to Moderate Support Needs Teaching Performance Expectations	CL-907	Verification Form for the Mild to Moderate Support Needs Teaching Performance Expectations
Verification of Requirements for the Emergency Transitional Kindergarten (ETK) Permit	CL-908	Verification of Requirements for the Emergency Transitional Kindergarten (ETK) Permit
Emergency Specialist Teaching Permit in Early Childhood Education	CL-909	Emergency Specialist Teaching Permit in Early Childhood Education
Military and Dependent Spouse Teaching and Services Credential Mobility	CL-910	Military Service
Teacher Performance Assessment Verification Form	CL-911	Verification Form for Teacher Performance Assessment
PK-3 Early Childhood Credential Requirements for Teachers Prepared in California	CL-912	PK-3 ECE Specialist Instruction Credential
Personal and Professional Fitness Explanation Form	OA-EF	Application forms and Fingerprint material
PROGRAM SPONSOR VARIABLE TERM WAIVER REQUEST	PS-VTWR	Waiver Applications and Forms
Waiver Application	WV1	Waiver Applications and Forms
Waiver Request30-Day Substitute for CBEST	WV1SUB	Waiver Applications and Forms
Multiple Subject Waiver Evaluation Worksheet	WV-MS	Waiver Applications and Forms
Education Specialist Waiver Evaluation Worksheet	WV-SPED	Waiver Applications and Forms
Single Subject Waiver Evaluation Worksheet	WV-SS	Waiver Applications and Forms

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Updated July 10, 2025