Plan to Complete Preliminary Administrative Credential

For Administrators in Training – Tier 1 Programs or Exams in Process

Administrative Candidate to complete this form if Administrative Credential or Certificate of Eligibility (CE) for an Administrative credential is not included in application packet.

NAME:	ID:

Please check one, or more. as applicable to your Administrative Program:

Administrative Credential Training in Progress

College or University attending for Preliminary Admin. program:

Anticipated Date of Program Completion:

CPACE Exams Taken - Date Passed:

Copy of Exams Attached

Administrative Tier 1 Completion Form/Letter - Dated:

College or University where program was completed:

Copy of Program Completion Form/Letter Attached

Filed with CTC for a Certificate of Eligibility (CE) – Date filed:

Copy of CE Attached

Please check one as applicable to your teaching/service experience:

Five (5) or more years teaching and/or service experience on base credential

from __________________ to __________________

Will have 5 years teaching and/or service experience on base credential

on: __________________

___________________________________	_____________

Candidate/Employee’s Signature	Date

Distribution:

HR File

Candidate

Form HR-CR4

Rev. 3/9/18