INITIAL EARLY CHILDHOOD ANCILLARY ... - Teach Louisiana

INITIAL EARLY CHILDHOOD ANCILLARY CERTIFICATION (ECAC) APPLICATION PACKET INSTRUCTIONS

Dear Louisiana Early Childhood Teacher/Service Provider: We are pleased that you are interested in obtaining a Louisiana ancillary certificate. This application packet is designed to facilitate the process of obtaining a renewable Early Childhood Ancillary certificate (ECAC), valid for 3 years. The ECAC authorizes an individual to teach in a publicly-funded early learning center serving children age birth to five as defined in R.S 17:407.33. There is NO certification fee required for the processing of this type of certification request.

Submitting application: Please submit a complete application packet (including required documentation) to the online educator certification portal. The following items are required as part of a complete application packet:

Application for Early Childhood Ancillary Certificate form with all information provided.

Professional Conduct form with all questions answered, signed, and dated by the applicant

Evidence for the Qualifying Certificate or Degree (See chart below.) Applicants must have one of the listed qualifying certificates or degrees, along with the corresponding required evidence, in order to qualify for the Early Childhood Ancillary Certificate.

Qualifying Certificate or Degree

Required Evidence

Child Development Associate (CDA) Copy of a current CDA (in infant/toddler or pre-K)

certificate awarded by the Council for Documentation of a high school diploma or equivalent

Professional Recognition AND a high Transcript showing completion of a BESE-approved

school diploma or equivalent

CDA program

If program is not BESE-approved, complete Qualifying

Training for CDA Addendum (page 4 of this application)

Approved Career Diploma where

Copy of a current career diploma approved by the

coursework began prior to July 1, 2018. Louisiana Pathways Career Development System

Documentation that coursework began prior to July 1,

2018 in order to qualify (example of course certificate,

enrollment notification)

Technical Diploma or Certificate of

Transcript showing the completion of a technical

Technical Study in an early childhood

diploma or certificate of technical study at a BESE-

related field from an accredited

approved Early Childhood Ancillary Certificate Program

technical or community college from a

or;

BESE-approved Early Childhood

Transcript showing the completion of a technical

Ancillary Certificate Program.

diploma or certificate of technical study where

documentation is provided that states that enrollment

began prior to July 1, 2018 ((example of course

certificate, enrollment notification).

Associate degree in early childhood

Official transcripts showing the completion of an

related field from a regionally

associate degree in an early childhood related field.

accredited college or university

Bachelor's degree or higher from a

Official transcript showing the completion of a

regionally accredited college or

bachelor's degree or higher degree.

university

Rev. March 25, 2021

Once the Early Childhood Ancillary Certificate is issued, it will need to be renewed every three years at no cost. The following items are required for renewal. Renewal is requested on the Early Childhood Ancillary Renewal application:

A. Individuals meeting eligibility requirements with a CDA, the early childhood ancillary certificate shall be valid for a three-year period. The ancillary certificate may be renewed by submitting: 1. A request from the applicant's Louisiana employing authority; and 2. Current CDA credential, awarded by the Council for Professional Recognition, or Documentation of: a. 4.5 CEUs, a three-credit-hour course, or 45 clock hours of training in early childhood care and education; and b. a minimum of 80 hours of work experience with young children or families with young children within the last three years.

B. Individuals meeting eligibility requirements with a bachelor's degree or higher, associate degree, technical diploma, certificate of technical studies, or career diploma, the early childhood ancillary certificate shall be valid for a three-year period. The ancillary certificate may be renewed by submitting: 1. A request from the applicant's Louisiana employing authority; and 2. Documentation of either 4.5 CEUs, a 3 credit-hour course, or 45 clock hours of training in early childhood care and education; and 3. Minimum of 80 hours of work experience with young children or families with young children within the last three years.

Additional Information: All application materials are to be sent electronically to the Louisiana Department of

Education as a single packet. Once the complete set of application materials is received, the application packet will be evaluated for purposes of issuing a Louisiana Early Childhood Ancillary certificate to the applicant.

Verifying Certification: The Louisiana Department of Education does not print and mail Louisiana teaching and/or ancillary certificates. You may verify issuance and print a copy of the certificate via Teach Louisiana at by clicking "Verify Teaching Certificate."

Early Childhood Ancillary Certificate FAQs: For answers to frequently asked questions about the Early Childhood Ancillary Certificate, view the FAQ document posted here.

Contact Information: All questions regarding certification requirements or the certification process, can be submitted online through the educator certification portal.

All applications will be evaluated in the order in which they are received. You can check the status of your certification application online HERE.

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INITIAL EARLY CHILDHOOD ANCILLARY APPLICATION

PLEASE TYPE OR PRINT IN INK

Social Security Number ______ - ______ - ______

Date of Birth _________________________

Name of Applicant:_____________________________________________________________________

(First)

(Middle)

(Maiden)

(Married)

Address: _____________________________________________________________________________

(Street)

(City)

(State)

(Zip Code)

Degree(s) Earned

EDUCATIONAL QUALIFICATIONS Institution(s)

Date Degree(s) Earned

CHECKLIST: Please indicate the materials that are included with this application.

Copy of a current Child Development Associate (CDA) certificate AND transcript from a BESE-approved CDA training program or Qualifying Training for CDA Addendum AND high school diploma or equivalent Copy of a current Career Diploma approved by Louisiana Pathways AND evidence that the training began prior to July 1, 2018 Transcript documenting a Technical Diploma in an early childhood related field earned from a BESE-approved Early Childhood Ancillary Certificate Program OR evidence that the coursework began prior to July 1, 2018

Official transcript documenting a completed associate's degree in an early childhood related field

Official transcript documenting a completed Bachelor's degree or higher

I agree that my electronic signature as entered below is the legal equivalent of my manual signature on this application. Signature of Applicant: ___________________________________________ Date: __________________

Employing Early Childhood Facility:_________________________________________________________

Facility Address: _________________________________________________________________________

Facility Phone Number: ______________________________________

STAFF SCHOOL READINESS TAX CREDITS (SRTC) ? OPT OUT: Some individuals may qualify for Louisiana's SRTC based on their obtainment of the Early Childhood Ancillary Certificate. In order to determine this, the Louisiana Department of Education will share the information included in this application with Louisiana Pathways (pathways.nsula.edu). Not all individuals will qualify for tax credits based on their Early Childhood Ancillary Certificate. If you do not want the LDOE to share your information with Louisiana Pathways, please sign below. By signing in the space to the right, I am opting out of allowing the LDOE to share information about my certification with Louisiana Pathways. I understand that my choice may impact my eligibility for a Louisiana Staff School Readiness Tax Credit.

3 Rev. March 25, 2021

QUALIFYING TRAINING FOR CDA ADDENDUM

ONLY REQUIRED IF CDA TRAINING PROGRAM WAS NOT BESE-APPROVED All applicants that are seeking to qualify for the Early Childhood Ancillary Certificate through a completed CDA certificate earned from a program that is not BESE-approved must complete this addendum. Applicants must check and sign the appropriate box below.

OPTION A: Candidates who have received an Approved Program Waiver may submit this addendum and a copy of the waiver documents in place of a transcript from a BESE-Approved Early Childhood Ancillary Certificate Program. I, the Ancillary Early Childhood certification applicant, hereby attest that I have been granted an Approved Program Waiver by the Louisiana Department of Education's Early Childhood Office. A copy of the waiver is included with this application. I agree that my electronic signature as entered below is the legal equivalent of my manual signature on this application. Applicant's Signature:____________________________________________________

Date: ______________________________

OPTION B: As of July 1, 2018, applicant completed 36 or more clock hours of training for the CDA certificate. The applicant was authorized to complete the remaining coursework for the CDA from any CDA provider. I, the Ancillary Early Childhood certification applicant, hereby attest that as of July 1, 2018, I completed 36 or more clock hours of training for my CDA certificate, and documentation of those clock hours may be audited by the Louisiana Department of Education's Early Childhood Office to ensure compliance. I understand that I was permitted to complete the remaining clock hours for my CDA with any CDA provider. I agree that my electronic signature as entered below is the legal equivalent of my manual signature on this application.

Applicant's Signature: ____________________________________________________

Date: ______________________________

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PLEASE TYPE OR PRINT IN INK

PROFESSIONAL CONDUCT FORM

(All questions must be answered)

NAME OF APPLICANT: (Include First, Middle, Maiden, and Married) ADDRESS:

Social Security Number:

______ - ______ -______

DATE OF BIRTH:

Each Question must be answered:

Please Check YES NO

1. Have you ever had any professional license/certificate denied, suspended, revoked, or voluntarily surrendered? If YES, in which state?____________________________

2. Are you currently being reviewed or investigated for purposes of such action as stated in #1 or is such action pending? If YES, in which state?_____________________________

3. Have you ever been convicted of any felony offense, been found guilty or entered a plea of nolo contendere (no contest), even if adjudication was withheld?

If yes, please provide the following information:

Date of Conviction: ____________________

State of Conviction: _____ Court Jurisdiction of Conviction: __________________

4. Have you ever been convicted of a misdemeanor offense that involves any of the following: a. Sexual or physical abuse of a minor child or other illegal conduct with a minor child. b. The possession, use, or distribution of any illegal drug as defined by Louisiana or federal law.

5. Have you ever been granted a pardon or expungement* for any offense as stated in #3 or #4?

NOTICE---EXPUNGEMENTS, FIRST OFFENDER PARDONS, PRE-TRIAL DIVERSIONS: Criminal Background Checks (CBCs) conducted for purposes of employment will be conducted in accordance with La. R.S. 17:15 and La. R.S. 15:587.1. Pursuant to Louisiana law R.S. 15:587.1., background checks shall disclose ALL ARRESTS, COURT ACTION and CONVICTIONS, (Including but not limited to expungements, first offender pardons and pre-trial diversion), and a copy of the report shall be provided to the Louisiana Department of Education (LDE), in addition to the potential employer or LA Education Agency (LEAs)s.

*Per BESE policy set forth in Bulletin 746, Louisiana Standards for State Certification of School Personnel, Section 903.C, "failure to disclose actions such as first offender pardons, pre-trial diversion, expungements, etc. is grounds for certification denial and/or revocation."

If you answered "YES" to any questions, #1 through #5, you must provide court certified copies of all documents and proceedings, civil records of Federal, State and/or District School Board actions, or other relevant documents that provide full disclosure of the nature and circumstances of EACH separate incident in your application packet.

I affirm and declare that all information given by me in the responses to items #1 through #5 above is true, correct, and complete to the best of my knowledge. I understand that any misrepresentation of facts, by omission or addition, may result in criminal prosecution and/or the denial or revocation of my teacher certificate. I agree that my electronic signature as entered below is the legal equivalent of my manual signature on this document.

SIGNATURE OF APPLICANT:

DATE:

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