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Fresno StateApplication for Education Specialist Credentials Mild/Moderate, Moderate/Severe and Deaf and Hard of Hearingsubmit application pages 4-5 with the following documentationPRELIMINARY EDUCATION SPECIALIST CHECKLISTFresno State transcripts with ALL grades posted. Unofficial transcripts printed fromyour my.fresnostate.edu account are acceptable.If you have passed RICA, please submit a copy.**Please note: RICA is suspended for the preliminary credential for candidateswho were enrolled in the program between March 19, 2020 and December 31,2021, and were unable to access the exam due to COVID 19 restrictions.Copy of the front and back of your valid CPR training card for infants, children andadults. The card must indicate all 3 levels of training were completed. Online CPRtraining is available from CPR Today at: www.cprtoday.com.Complete the CSU exit survey at https://www.csuexitsurvey.org/. Campus code: FSCPrint out the verification at the end of the survey. 25.00 Fresno State processing fee receipt. See instructions on page 3.Copy of your completed Individualized Development Plan (IDP)For questions, please email the Credential Analyst, Sherri Nakashima at [email protected]no.eduProcessing time can take up to 20 business days during peak periods.If you currently hold a California CLEAR Multiple or Single Subject teachingcredential, you may apply for the CLEAR Education Specialist credential instead of thePreliminary. Please contact the Credential Analyst to request a different application.NOTE: If you are applying to add on a Mild/Mod or Mod/Severe authorization on to anexisting Education Specialist credential, please email the Credential Analyst. There isa different application for this process.11-10-22 sn

Commission on Teacher CredentialingAfter submitting your complete application packet you will receive three email notifications.1. Authorization to pay credential fee at http://www.ctc.ca.gov/credentials/default.html. Fee: 102.50You will only be allowed to pay your fee after you have received this email notification. Avalid email and credit/debit card are required. The fee will be less if you hold a currentCertificate of Clearance. Click the “Complete your Program’s Recommendation” button to begin your part of theonline process. Review the instruction video before proceeding as you may apply for the incorrectcredential and will have to pay the fee again as there are no refunds.2. Payment ConfirmationPrior to receiving your final email, your local County Office of Education (COE)credentials department will accept this payment confirmation email as a temporaryconfirmation until your document number is issued.If you have a conviction record or you have answered yes to any of the fitness questions,your application process may be delayed as CTC verifies your information.3. After CTC completes their review, you will receive your document number.You must register a copy of the final CTC email with your document number at your localCOE credentials department.The average processing time is approximately 7-10 days after payment.21-10-22 sn

Kremen School of Education and Human DevelopmentFresno State Credential Processing FeeThere is a 25 Fresno State processing fee for applying for yourcredential. This fee is required to be paid online.Please go to this link:https://commerce.cashnet.com/fresnoem kremencenterforadvisingYou may pay by credit or debit card. Please note there is a 2.65% addedservice charge fee for each transaction.Payment can also be made by electronic check without any additionalservice charges.If you are applying for two credentials (Multiple Subject and EducationSpecialist, or Single Subject Agriculture and Ag Specialist), there aretwo processing fees.Please keep your receipt and include a copy/copies with your credentialapplication paperwork.1-10-22 sn

Fresno StateApplication for Education Specialist CredentialsMild/Moderate, Moderate/Severe and Deaf and Hard of HearingStudent ID#Last 4 digit SSNDate of BirthLast Name:First Name:Former Names, If AnyMailing Address:Phone Number (including area code):Email address used on your CTC profile:Check your profile on: www.ctc.ca.gov. Updating your email address will require you to create a username and password.1. BA/BSDate GrantedMajor2. Have you held a university internship credential? YES NO Check the Credential you are applying for:PRELIMINARY EDUCATION SPECIALIST:Mild/ModerateModerate/SevereDHHBAP Spanish/HmongIndicate the School District and COUNTY where you are employed:Mail or bring the application (DO NOT EMAIL) to:Sherri Nakashima, Credential Analyst Kremen Schoolof Education and Human DevelopmentCenter forAdvising and Student Services, ED 1005005 N. MapleAvenue, M/S ED301 Fresno, CA 93740-80251-10-22 sn4

OFFICE USE ONLY – DO NOT WRITE ON THIS PAGEFSU fee Fingerprint clearanceFirst Credential:Degree Constitution BSR SMCRICA CPR TK20CI 100Exit Survey IDPSPED 120PRELIMINARY M/M or M/S:LEE 158 LEE 159 CI 176 SPED 145 EHD 178 EHD 178ALEE 166 SPED 125 SPED 130 SPED 136/146 SPED 171/172 EHD170A SPED 219 SPED 233 SPED 246/247 SPED 175/176PRELIMINARY DUAL M/M or M/S:CI 158 LEE 159 LEE 160 CI 162 CI 163 SPED 145LEE 166 LEE 167 CI 175 CI 176 SPED 136/146 EHD 110DSPED 130 SPED 246/247 LEE 169 EHD170SPED 125 SPED 219 SPED 233 SPED 175/176BAP Spanish: CI 135 LEE 136 LEE 137BAP Hmong: HMG100 101 LEE 129 135 ANTHRO 123DATE SENT TO CTC:DATE CTC ISSUED:ISSUANCE DATE: EXPIRATION DATE:PRELIMINARY EDUCATION SPECIALIST: MILD/MOD MOD/SEVEREDHHSemester completedPSERST51-10-22 sn

Fresno State . Application for Education Specialist Credentials . Mild/ Moderate, Moderate/Severe and Deaf and Hard of Hearing . . Kremen School of Education and Human Development Fresno State Credential Processing Fee There is a 25 F