Clear Administrative Services Credential Program Application and Agreement

Date

MonthDayYear

First name*

Last name*

Title*

District*

District

School / Department

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Number*

Area CodePhone Number

Cell Number

Area CodePhone Number

Work Number

Area CodePhone Number

Work E-mail*

Personal E-mail

Supervisor

Supervisor Title

Preliminary Credential #*

Preliminary Credential Expiration *

MonthDayYear

Years of Administrator Experience - CA*

Years of Administrator Experience - Out-Of-State

Attach a narrative briefly describing each of the following:

Candidate’s background and experiences. *

Candidate’s current job responsibilities.*

A description of your school, department, or district (demographics, background, strengths, challenges…).*

Candidate’s professional areas of strength.Candidate’s professional challenges or barriers.Candidate’s professional goals.*

Candidate’s learning style as an adult learner.*

Please read the following agreements as a Pomona Clear Administrative Services Credential Candidate:

(Agreements as a Pomona Clear Administrative Services Credential Candidate).

If you cannot access the link above there is a text version below.

POMONA UNIFIED SCHOOL DISTRICT

Clear Administrative Services Credential Program Application and Agreement

Agreements as a Pomona Clear Administrative Services Credential Candidate:

Understand that that the Pomona Clear Administrative Services Credential Program runs two full school years, will cost $5,000, and it is my responsibility to make timely progress toward completing the Program within the two-year timeline.

Review my eligibility and progress for the Clear Credential Program with the Program Coordinator by attending advisement sessions.

Attend and fully participate in the following program requirements:
-Coaching collaborations and site visits (40 hours or more per year);
-Completion of program Portfolio requirements and competencies as defined by CPSELs and PACCP (such as Collaborative logs, Learning Designs, Individual Induction Plans, assessments);
-Professional development sessions (21 hours of common professional development and 8 or more ours of individualized professional learning; and
-Program assessments and surveys.

Regularly utilize the learning management system to network with colleagues, access program resources, register for professional events and monitor progress towards program completion.

Understand that should questions or concerns arise about the match with my Coach, or any program completion requirements, it is my responsibility to contact the Program Coordinator as soon as possible.

Acknowledge that the program costs $2,500 per year, $5,000 total.

Acknowledge that it is my responsibility to collect and submit all required evidence for program completion, and at the end of Year 2, prepare and descend Portfolio in a Summative Review Process.

Acknowledge that if I do not fulfill all of the Program requirements and/or responsibilities, I will not receive a recommendation for the Clear Administrative Services Credential.

Acknowledge that the Program requirements and responsibilities leading to completion of the Clear Administrative Services Credential do not imply or ensure continued employment in PUSD, nor will information submitted be used for employment evaluation purposes.

By completing and signing this application, I certify that I wish to participate in the PUSD Clear Administrative Services Credential Program.

Have you read and understood the Agreement.*

Yes, I have read the Agreement

By completing and signing this application, I certify that I wish to participate in the PUSD Clear Administrative Services Credential Program.

E-Signature:*

Clear Administrative Services Credential Program Application and Agreement

Candidate E-Signature