CSU East Bay Logo   Department of
  Educational Leadership

Department Application for Admission to the
Professional Administrative Services Credential Program (Tier II)


Department of Educational Leadership
CSU East Bay
APPLICATION DEADLINE: JANUARY 1 - Until filled
First Name
Last Name
SSN - -
Home street
City
Zip
Home phone () 
Home fax () 
Home email
Summer address and email
(if different from above)

Note: An email address acessible through the summer
(home or work) is required to apply online.
School District
School/site
Level
High School  Jr. High/Middle  Elementary 
K-12  other: (specify)  
Your role / title
Asst.Principal
Principal
Director
Other:(specify)
Current Supervisor  
Superintendent
Asst.Superintendent
Principal
Director
Other:(specify)  
Work address
Work city
Work zip
Work phone ()
Work fax ()
Work email
Provide a brief description of your job duties (<75 words)
(Optional) Select your ethnic identity from the box below:

This application form provides you with an opportunity to report your primary racial or ethnic identity. Neither you nor others can view any data collected on this Web site. Any information you submit is confidential.
Do you have an Intern Credential?  Yes  No
If so, when does it expire? 
Do you have a Preliminary Administrative Credential? Yes  No
Where did you complete your Preliminary Administrative Credential? 
When does it expire?    Has it already been renewed? Yes  No
Select a campus preference: 
Hayward
Contra Costa 
No preference
Do you intend to pursue a Master's degree?
Yes No 
California State University, East Bay, 25800 Carlos Bee Boulevard, Hayward, CA 94542, (510) 885-3000
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