INITIAL EARLY CHILDHOOD ANCILLARY ... - Teach Louisiana

Application Type -EC

INITIAL EARLY CHILDHOOD ANCILLARY CERTIFICATION (ECAC) APPLICATION

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. The ECAC is NOT a standard teaching certificate.

Submitting application: Please submit a complete application packet (including all required documentation below) to the online educator certification portal. No Application fee is required for this type of certificate.

1. Copy of Applicant's Social Security Card and Driver's License/Official Photo ID (required with every application) 2. Application form with all information provided, signed and dated within the last 90 days

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

4. Documentation Evidence for Qualifying Certificate or Degree (must have at least ONE of the listed qualifying certificates or degrees, along with the corresponding required evidence in order to qualify for the ECAC):

Qualifying Certificate or Degree

Child Development Associate (CDA) certificate awarded by the Council for Professional Recognition AND a high school diploma or equivalent

Required Evidence

Copy of a current CDA (infant/toddler, preschool or family childcare) Documentation of a high school diploma or equivalent Transcript showing completion of a BESE-approved CDA program If the program is not BESE-approved, and training began before July 1,

2018, a transcript, detailed list of hours, or expired CDA certificate is required to verify the number of hours completed before July 1, 2018

Approved Career Diploma where coursework began prior to July 1, 2018.

Copy of a current career diploma approved by the Louisiana Pathways Career Development System

Documentation that coursework began before 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 diploma or certificate

Technical Study in an early childhood

of technical study at a BESE-approved Early Childhood Ancillary

related field from an accredited

Certificate Program or;

technical or community college from a Transcript showing the completion of a technical diploma or certificate

BESE-approved Early Childhood

of technical study where documentation is provided that states that

Ancillary Certificate Program.

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

enrollment notification).

An associate degree in an early childhood related field

Official transcripts showing the completion of an associate degree in an early childhood related field from a college or university accredited in accordance with 34 CFR 602.

Bachelor's degree or higher

Official transcript showing the completion of a bachelor's or higher degree from a college or university accredited in accordance with 34 CFR 602.

Renewal requirements: The ECAC is valid for three years and is renewable. Renewal is requested on the Early Childhood Ancillary Renewal application. The following items are required for renewal:

1. A request from the applicant's Louisiana employing authority; and

2. Current/renewed CDA credential, awarded by the Council for Professional Recognition, OR Documentation of either a 3 semester-hour course in early childhood care and education completed within the last three years OR 45 clock hours of approved training or professional development in early childhood care and education, completed within the last three years; and

3. Minimum of 80 hours of work experience with young children or families with young children within the last three years.

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 on by clicking "Verify Teaching Certificate."

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

Rev: 6/1/2024.- Pg. 1

Application Type -EC

Handwritten documents will not be accepted for certification processing.

Social Security Number ______________________ Email Address: __________________________________

(no dashes, no spaces)

Legal Name of Applicant: ___________________________________________ Date of Birth: ___________________

Address: _____________________________________________________________________________

(Street)

(City)

(State)

(Zip Code)

Phone: (____) ________________

EDUCATIONAL QUALIFICATIONS (must be documented with transcript/equivalency transcript)

Degree(s) Earned

Institution(s)

Date Degree(s) Earned

QUALIFYING DOCUMENTATION (Check all that apply, indicating the items included with this application): Copy of a current Child Development Associate (CDA) certificate AND transcript from a BESE-approved CDA training program OR training transcript, detailed list of hours, or expired CDA certificate verifying the number of hours completed before July 1, 2018 AND high school diploma or equivalent Copy of a current Career Diploma approved by Louisiana Pathways AND evidence that the training began before 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 before July 1, 2018 Official transcript documenting an associate's degree awarded in an early childhood related field Official transcript documenting a Bachelor's degree or higher awarded

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 (). 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.

Rev: 6/1/2024.- Pg. 2

APPLICANT'S LEGAL NAME: ADDRESS (Street Address, Including City, State, Zip):

Professional Conduct Form

SSN (No Dashes):

DATE OF BIRTH (MM/DD/YYYY):

ANSWER ALL QUESTIONS

1. Have you ever had a professional license or certificate denied, suspended, revoked, censured, or voluntarily surrendered? If YES, what type of professional license/certificate?_________________________ If YES, in which state?____________________________

Check

YES NO

2. Are you currently being reviewed or investigated for purposes of such action as stated in #1 or is such action pending?

3. Have you ever been convicted of a criminal offense? If YES, when was the date of conviction: _____________________

If you answered "YES" to any of the questions above, you must provide copies of any proceedings or other relevant explanatory documents that provide full disclosure of the nature and circumstances of EACH separate incident to be included with the application packet.

Pursuant to Louisiana law R.S. 15:587.1, background checks shall disclose ALL CONVICTIONS, (Including but not limited to expungements, first offender pardons and pretrial diversion). Criminal Background Checks (CBCs) are conducted in accordance with La. R.S. 17:15 and La. R.S. 15:587.1.

BESE policy set forth in Bulletin 746-Louisiana Standards for State Certification of School Personnel addresses actions related to the suspension, denial, and revocation of Louisiana Certificates.

I affirm and declare that all information given by me in the responses to items #1 through #3 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,

typed signature as entered below is the legal equivalent of my manual signature on this document.

SIGNATURE OF APPLICANT:

DATE SIGNED:

Rev. August 30, 2023

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