CDA Credential Application

First Name(required)

Last Name(required)

Center Name(required)

If Home-based please add licensed or registered name

If Emeritus please add center name

Center Director (Name)(required)

Director Email address(required)

EFS Specialist Name(required)

Applicant Address(required)

City, State, Zip(required)

County(required)

Phone Number (Home)(required)

Phone Number (Cell)(required)

Applicant Email address(required)

Must be different than center and director email address

Date of Birth(required)

Gender(required)

Ethnicity(required)

What is your current job title?(required)

Teacher

Assistant Teacher

Director

Assistant Director

Other

If other, please specify:

What age group do you work with?(required)

Infants (0-12 months)

Toddler (13-36 months)

Preschool (3-5 years)

School Age (5+ years)

How many children are in your classroom?(required)

How many hours per week do you work?(required)

How many months per year do you work?(required)

What is your length of employment at the current center?(required)

Less than 6 months

Greater than 6 months

How long have you worked in the field of early childhood?(required)

Less than 2 years

2-5 years

6-10 years

10+ years

Please check the box that describes your highest level of education:(required)

High School Diploma/GED

Certificate

Some College (course(s))

Associate Degree

Bachelor Degree

Other

Please specify Certificate, Some College, Associate Degree, Bachelor Degree or Other:(required)

Have you previously been enrolled in a CDA course(s):(required)

Yes

If yes, when & where:(required)

Did you complete the course(s):(required)

Yes

If no, please explain:(required)

Please check box that best describes your educational goals:(required)

Take a few early childhood training courses to gain or improve job-related skills.

Earn an Early Childhood Infant/Toddler, Preschool, or School-Age CDA

Earn an Early Childhood Associate Degree

Earn an Early Childhood Bachelor's Degree

Other:

If other, please explain:

Are you CPR/First Aid Certified?(required)

Yes

If yes, expiration date:

What language(s) do you speak fluently?(required)

What are your professional goals in Early Childhood Education? Describe how the CDA will help you achieve these goals.(required)

Which CDA Class would you like to attend?

Disclaimer: Class preference will be considered. However seats are limited and on a first come, first serve basis.

Student Scholarship Agreement

I agree to participate in the 20 week CDA course offered by Educational First Steps. I commit to the following course expectations: 1. Be present and on time to class (2 absences will be excused upon reasonable explanation) 2. Participate in group activities 3. Complete homework assignments (If absent, you will be expected to make up all assigned coursework/homework) 4. EFS will supply course books; Student is responsible for class supplies (notebook, paper, writing utensils, etc.) 5. Complete the course with a grade of “C” or higher. I understand that failure to comply with the expectations listed above may result in withdrawal from the course. I understand early termination or withdrawal from the course will result in a fee for reimbursement of the scholarship amount- this amount is calculated by the number of classes I attend. Additionally, I understand that in order to obtain the CDA Credential, I will be required to complete: 120 training clock hours, a classroom observation conducted by a Professional Development Specialist (a representative of the CDA Council), and a final test conducted by the Council for Professional Recognition. I agree to complete the observation visit and the test within 3 months of completion of the course. I understand that the CDA Certificate is not awarded by Educational First Steps, but by the Council for Professional Recognition, and that upon the completion of all of the aforementioned CDA requirements, the Council has the final decision in which to award the CDA Credential. Furthermore, I understand that the CDA certificate will come directly from the Council for Professional Recognition.

Student Signature (Please Type)(required)

Today's Date:(required)

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