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
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Email
example@example.com
LEA or District Name*
Current Position/Title*
Name of School or Work Site*
School Address/Work Site*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School/Work Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Total Years of Teaching/Education Service with a Valid California Credential
Years Teaching?
w/Prelim
Private
Out of State
Out of Country
Total Years
Other Services
Other Service Total Years
Current Supervisor Name

First NameLast Name
Supervisor Title
Supervisor Phone
Please enter a valid phone number.Format: (000) 000-0000.
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.Format: (000) 000-0000.
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
District/LEA Human Resources Contact
Name

First NameLast Name
Title
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Email
example@example.com
Are You Currently in an Administrative Role?

YesNo
If Yes, Are You On a CTC Waiver?

YesNo
Do You Require Accomodations?

YesNo
If Yes, Please List 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
Score
Date

MonthDayYear
Date
CPACE

If applicable
CPACE Score
Institution
Date

MonthDayYear
Date
Description of Work Assignment - Please describe your current 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.
Description of Work Assignment - Please describe your current 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.
Work Assignment Description
Current Resume Upload*

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Current Valid California Credential*

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Preliminary Administrative Credential or Certificate of Eligibility Upload

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

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CBEST Scores

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Verification of Basic Skills Requirement Upload

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Letter of Recommendation From Current Supervisor

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Letter of Recommendation

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Upload Your Why Statement (1-2 Statements)

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Should be Empty:

ELP Application

Years Teaching?

District Info

District/LEA Human Resources Contact

Demographics

Degrees Earned

California Credential

Score on CBEST

CPACE