ELP Application

ELP Application
Personal Email*
example@example.com
For which program are you applying?

Preliminary Administrative Services Credential (PASC)Clear Administrative Services Credential (CASC)
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Cell Phone Number*
Please enter a valid phone number.
Alternate Email
example@example.com
District Name*
Current Position/Title*
Name of School*
School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School/Work Phone*
Please enter a valid phone number.
Years Teaching?
w/Prelim
Private
Out of State
Out of Country
Total Years
Other Services
Other Service Total Years
Supervisor Name

First NameLast Name
Supervisor Phone
Please enter a valid phone number.
Supervisor Email
example@example.com
Supervisor Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
District Info
District Administrator Department
Contact Name
Contact Title
Contact Phone
Please enter a valid phone number.
Contact Email
example@example.com
Current Assignment for Teachers/Service Providers

ElementarySecondaryOther
Current Assignment for Administrators

Full TimePart Time
Total Years of Administrative Experience
Do you supervise classified staff?

YesNo
Do you supervise certificated staff?

YesNo
Accommodations
English is my first language

YesNo
First Spoken Language?
I also speak
Demographics

These optional questions are required by Assembly Bill 677. If you wish not to answer, there is an option to decline to state.
Sexual Orientation

HeterosexualBisexualGay/LesbianOtherNot sureDecline to state
Preferred Pronoun
Gender Identity

MaleFemaleNon-binaryDecline to state
Ethnicity (check all that apply)

American Indian or Native AlaskanAsianBlack or African AmericanHispanic or LatinxPacific IslanderWhiteTwo or more racesDecline to state
Degrees earned
Name of institution
Degree earned
Date received

MonthDayYear
Date
Name of institution
Degree earned
Date received

MonthDayYear
Date
Name of institution
Degree earned
Date received

MonthDayYear
Date
Name of institution
Degree earned
Date received

MonthDayYear
Date
California Credential
Credential
Expiration Date

MonthDayYear
Date
Credential
Expiration Date

MonthDayYear
Date
Credential
Expiration Date

MonthDayYear
Date
Credential
Expiration Date

MonthDayYear
Date
Score on CBEST
Type a question
Date

MonthDayYear
Date
Score on CPACE

If applicable
CPACE Score
Institution
Date

MonthDayYear
Date
Description of Work Assignment - Please describe your administrative position and job responsibilities. Include position title, duties, demographic of assignment (i.e. urban, rural, suburban, specialty school, student body socioeconomic) and any designations or specific programs in place (i.e. Dual Immersion, Special Education, Gold Ribbon, Red and Orange Performing Schools/Districts, etc.). Your explanation will help us identify a Leadership Coach who has had a similar job-alike experience.
Work Assignment Description
Current Resume Upload*

Cancelof
Preliminary Administrative Credential or Certificate of Eligibility Upload

Cancelof
Verification of Employment/Financial Obligation Statement Upload (located in application process tab) *

Cancelof
Verification of Basic Skills Requirement Upload

Cancelof
Letter of Recommendation

Cancelof
What is your WHY statement?

Cancelof
Should be Empty:

ELP Application

Years Teaching?

District Info

Demographics

Degrees earned

California Credential

Score on CBEST

Score on CPACE