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SAC CREDENTIAL APPLICATION...
Complete the following application and mail to:
Child Care Resource Network
Education Department
Att: Karen A. Scott
1000 Hertel Avenue
Buffalo, New York 14216
Candidate Application
New York State School-Age Care Credential
This application will be used to evaluate your education and experience and to determine you meet the eligibility requirements as well as measure your competency in the fourteen skill areas of the NYS School-Age Care Credential. Information that you provide will also be used by you and your Advisor to assess your beginning level of competency and develop an individualized training plan.
Please use blue or black ink and print clearly.
Applicant Information
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Name
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Soc. Sec. #
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Address
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City
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State
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Zip Code
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Day Phone
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Night Phone
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E-mail Address
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Current Work: Must currently provide school-age care and work directly with children; must have experience working with school-age children in a NYS registered or licensed program.
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Place of Employment
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Dates
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Address
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City
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State
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Zip Code
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Supervisors Name
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Phone
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_________________________ (Candidate Name) has my support to participate in the SAC Credential program.
Supervisor Signature __________________________________________________Date ___________
Work History
_________________________ (Candidate Name) has my support to participate in the SAC Credential program.
Supervisor Signature __________________________________________________Date ___________
Work History
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Place of Employment
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Dates
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Nature of Work
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Education (High School or GED)
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School
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Dates
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Major Course of Study
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Please list and provide transcripts of coursework that is relevant to school-age care.
List topics of training (workshops, inservice, and/or other learning) that relate to the school-age care field:
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Topic
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Hours
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Where acquired
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Please provide copies of training certificates. Use additional sheet of necessary.
Why do you want to obtain the NYS School-Age Care Credential?
How do you expect that obtaining the NYS School-Age Care Credential will forward your career?
What are your strengths as a school-age care professional?
What are areas and skills that you wish to acquire and/or develop as a school-age care professional?
I understand that a $50.00 non-refundable registration fee is required
at the time of acceptance into the SAC Credential program.
I certify that the information provided is accurate and true. I understand that falsifying any of the above information may result in my not being accepted into the New York State School Age Care Credential Program.
SIgnature of Applicant ______________________________________ Date __________________
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