EDUCATION SPECIALIST PROVISIONAL INTERNSHIP PERMIT
Evaluation Worksheet
State of California
Commission on Teacher
Credentialing Certification Division
Email: [email protected]
Website: www.ctc.ca.gov
Name: ______________________________________________Degree Major: ______________________________
Select area(s) of specialization:
Mild to Moderate Support Needs
Deaf & Hard of Hearing
Option 1
Verify a minimum of three years of successful full-time classroom experience (or the equivalent in part-time
experience) working with special education students. Experience as an aide is acceptable. This experience must be
verified by a letter from the employing agency and included in the application packet.
Option 2
Verify completion of a minimum of nine semester units of course work* in special education or in a combination of
special education and regular education.
Option 3
Must have 40 semester units including 10 semester units of course work* in each of at least four of the following
subject areas or at least 10 semester units of course work in each of three of the subject areas and an additional
10 semester units in a combination of two of the remaining subject areas.
LANGUAGE STUDIES (Literature,
Composition, Foreign Language,
Language Acquisition, Speech,
Linguistics, English)
Grade Qtr Sem
LITERATURE (American, Foreign)
Grade Qtr Sem
HISTORY SOCIAL SCIENCE (History, Government, Geography,
Economics, Political Science, Sociology, Anthropology,
Psychology)
MATHEMATICS SCIENCE (Biology, Chemistry, Physics, Geosciences)
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Complete the requirements in one of the options listed below:
Visual Impairments
Extensive Support Needs
Early Childhood Special Education (cannot stand alone)
HUMANITIES (Art, Music, Dance, Classics, Comparative Arts,
Comparative Literature, Ethics, Logic, Philosophy, Foreign
Languages, Ethnic Studies, Linguistics)
VISUAL/PERFORMING ARTS (Art, Music, Dance, Aesthetics,
Criticism, Drama, Production)
PHYSICAL EDUCATION (Physical Fitness and/or Movement
Skills, Recreation, Sports)
HUMAN DEVELOPMENT (Intellectual, Social, Physical,
Emotional and/or Moral Development During Childhood and
Adolescence, Health Science, Nutrition, Psychology)
Option 4
Must have at least 18 semester units, or 9 upper division semester units, of course work in a subject that can be listed on a Single
Subject Credential. When evaluating for one of the science subjects, at least nine semester units must be in the specific science
area. For Foundational-Level General Science, an individual must either verify a bachelor’s or higher degree in science (does not
include health science) or verify 18 semester units (or nine upper division semester units) across the four science areas of
biological science, chemistry, geosciences, and physics. A minimum of one course in each of the four areas is required.
Dept.
Course
Number
Course Title
Semester
Units
Quarter
Units
Grade
TOTAL UNITS ________________
* All course work must meet the following criteria:
Must be completed at a regionally-accredited college or university
Must be baccalaureate degree-applicable (non-remedial)
Must be earned with a "C" grade or higher ("Pass" and "Credit" grades meet this requirement)
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