North Carolina Education And Equivalency Form For Child Care Lead Teachers printable pdf download

NORTH CAROLINA EDUCATION AND EQUIVALENCY FORM FOR CHILD CARE LEAD TEACHERS

(See back of form for instructions)

This form only needs to be completed and submitted to the Division of Child Development** ONCE.

Changes to any of the applicant or facility information should be submitted on a DCD.0120 Change of Information form, NOT a new DCD.0013

Lead Teacher form.

A) Applicant Information

Social Security #

Legal Name

Legal Maiden Name

Last

First

Middle

Home Mailing Address

City

State

Zip

Date of Birth

Home Telephone # (

)

County of Residence

B) Facility Information

Date of Employment for Lead Teacher Position in This Facility

Name of Facility

County

Mailing Address

City

State

Zip

Facility License #

Facility Telephone # (

)

FAX # (

)

C) Educational Background (check ALL that have been completed)

Attach official transcripts (NOT photocopies, student copies or grade reports) for ALL completed college coursework, certificates, diplomas and/or degrees.

GED

High School Diploma

AA/AAS

BA/BS

MA/MS

Ed.D./Ph.D.

Program Major (s)

School(s)

D) N.C. Early Childhood Credential Coursework Information (Check both course I & II if you completed EDU 119)

N.C. Early Childhood Credential (NCECC) course I: Completed

Currently Enrolled

Plan to Enroll

Date

________

N.C. Early Childhood Credential (NCECC) course II: Completed

Currently Enrolled

Plan to Enroll

Date

Received NCECC certificate issued jointly by the Division of Child Development and the N.C. Community College System

(Attach copy of NCECC certificate)

DO NOT COMPLETE SECTION E IF YOU COMPLETED SECTION D, PROCEED TO SECTION F.

E) N.C. Early Childhood Credential Equivalency Options (check ONE option only) OPTIONS RECEIVE EQUIVALENCY LETTER ONLY

Request to test out of the Division of Child Development NCECC standardized equivalency test.

Have successfully tested out of the Division of Child Development NCECC standardized equivalency test. (Attach copy of letter)

2. Completed and currently active_____ Child development, early childhood, human growth & development/special education or child care credential(s) certificate

that meets the following six criteria:

Nationally accredited and available in all 50 states,

Comprehensive in scope which is inclusive of the following six areas: child growth and development;

professionalism; health and safety; creation of appropriate environments that enhance physical, emotional, social and cognitive development; developmentally

appropriate learning activities; and working with families,

120 clock (contact) hours of education and/or training,

) Formal observation and/or portfolio

assessment,

Standardized written assessment and

) Individually earned. (Attach copy of certificate)

Applicants requesting to be assessed for options 3-6 must attach official transcripts (not photocopies, student copies or grade reports) for ALL

completed coursework, diplomas, certificates and/or degrees received to meet these requirements.

3. Completed_____

Early Childhood Certificate, Diploma or AAS Degree from an accredited* Community College.

4. Completed_____

BS/BA degree (or higher) in Early Childhood/Child Development/Human Growth and Development (with or without B-K certification) from

an accredited* institution of higher education.

5. Completed_____

BS/BA degree (or higher) in any area plus 12 semester credit hours (sch) in the course of study of Early Childhood/Child

Development/Human Growth & Development/Special Education programs with at least 3 sch in Child Growth and Development from an accredited* institution of

higher education.

6. _____ Receipt of 12 sch in the course of study of Early Childhood/Child Development/Human Growth & Development/Special Education programs with at least

3 sch in Child Growth and Development from an accredited* institution of higher education. Attach official transcripts (not photocopies, student copies or

grade reports) for ALL completed degrees and/or coursework. For all coursework over 10 years old to be eligible for this NCECC equivalency, you must

be currently enrolled in a degree program. (Attach proof)

* Accredited is defined as nationally recognized higher education regional certification. (For higher education institutions outside of the United

States, the recognized system of the specified country’s accreditation process will be accepted).

F) This statement must be signed and dated by the applicant AND legal operator (or his/her legal representative) of this child care facility. Both

parties attest to the accuracy of the above information.

Applicant

Date

Legal operator or legal representative of child care facility

Date

NOTE: EMPLOYING FACILITY MUST RETAIN A COPY OF THIS FORM IN THE LEAD TEACHER’S PERSONNEL FILE.

APPLICANT SHOULD ALSO RETAIN A COPY OF THIS FORM FOR HIS/HER FILE.