Credential Application Form

Credential Application Form

This form is to be used by all candidates enrolled in credential preparation programs at the Kalmanovitz School of Education (KSOE). Additional information regarding the credential process can also be found through the Credential Office website.

ACKNOWLEDGMENT

Candidates should only use this form after they have completed and submitted all requirements of the program. 

First Name *

Middle Initial

Last Name *

SMC ID Number *

Date of Birth *

Please provide month, day and year. Example format: 00/00/0000

Personal Email *

RICA Deferral * - Select -I am eligible for the RICA deferral and request that it is used for my Preliminary Credential applicaiton.I am not eligible for the RICA deferral and do not request that it is used for my Preliminary Credential application.I am a SSTE, PASC, or PPS candidate and am not required to complete RICA.

This CTC flexibility allows MSTE and SPED candidates to defer the RICA prior to earning a Preliminary Credential only if the candidate was unable to complete it between March 19, 2020, and June 30, 2022, due to testing center closures or capacity issues related to COVID-19. To use this flexibility, candidates must apply for their credential before the RICA deferral expires on June 30, 2022.

EdTPA Deferral * - Select -I am eligible for the TPA deferral and request that it is used for my Credential Applicaiton.I am not eligible for the TPA deferral and do not request that it is used for my Credential Application.I am a SPED or PPS candidate and am not required to complete the TPA.

This CTC flexibility allows MSTE, SSTE, and PASC candidates to defer the TPA prior to earning the Credential only if the candidate's completion of TPA was impacted by school site closures related to COVID-19, was in the process of completing TPA at the time of school closure, was unable to complete the performance assessment due solely to school closures. To use this flexibility, candidates must apply for their credential before the TPA deferral expires on August 30, 2022.

Type of Credential * - Select -Administrative Services Credential (Certificate of Eligibility)Administrative Services Credential (Preliminary)PPS School Counseling CredentialPPS School Psychology CredentialEducation Specialist: Mild/Moderate Teaching Credential (Preliminary)Multiple Subject Teaching Credential (Preliminary)Single Subject Teaching Credential (Preliminary)

If Single Subject, specify subject area * - Select -ArtEnglishMathematicsMathematics: FoundationalMusicPhysical EducationScience: FoundationalScience: BiologyScience: ChemistryScience: PhysicsSocial ScienceWorld Languages: FrenchWorld Languages: SpanishWorld Languages: Other

Acknowledgement

By submitting this document I am indicating that I have met the following requirements and I am ready for the Credential Analyst to begin reviewing my credential application for submission to the CTC:

  • I have met all KSOE program requirements.
  • The above email and phone number will be valid for 90 days.
  • I understand that I must pay for my credential on the CTC website within 90 days of receiving my CTC recommendation email.
  • I have confirmed that my CTC account has accurate and current contact information for me (www.ctc.ca.gov)
  • I understand the conditions required for using the RICA (PSA 21-13) and TPA (PSA 21-12) deferrals. 

I have read and agree to the statement above. *

I agree

 

Leave this field blank

© 2025 Saint Mary’s College of California