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Distance Learning Application


 

 

 

 

 

 

 

Text Box: Candidate Application for Distance Learning SAC Credential Prep Course Text Box: This application will be used to evaluate your education and experience, to determine that you meet the eligibility requirements, and to measure your competency in the fourteen skill areas of the NYS School-Age Care (SAC) 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. For non-NYS participants, please answer each question as it relates to your state systems.

 

 Applicant Information

Name

 

Social Security Number

  

Home Mailing Address (Please include street address, City, State and Zip Code)

City

State

 

Zip code

Home Phone (including area code)

 

Work Phone (including area code)

E-Mail Address

  
     

 

 

Text Box: Please include your supervisors name and contact information below so we can contact them regarding their support for your participation in the SAC Credential program. Text Box: Current Work: You must currently provide school-age care and work directly with children; and have had, within the past 3 years, at least 480 hours of experience working with school-age children in a registered or licensed program.

Place of Employment

  

Dates of Employment

Work Mailing Address (Please include street address, City, State and Zip Code)

 

City

State

Zip Code
       

 

 

 Supervisor’s Name     

 Phone       Email   

Why do you want to obtain the NYS School-Age Care Credential?

 

 

 How do you expect that obtaining the NYS School-Age Care Credential forward your career?

 

 

 What are your strengths as a school-age care professional?

 

 

What areas and skills do you wish to acquire and/or develop as a school-age care professional?

 

 

 Please check all that you have access to:

                             high speed internet           digital camera

                             DVD player                       VCR

                            inexpensive long distance phone service

                            other equipment or service that could be helpful for distance learning course (Please explain.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone:   518.694.0660      Fax: 518.694.0661      Email:  SACCredential@nyssacc.org

Mail:             230 Washington Ave. Ext., Albany, New York 12203

Contact Sally Crosiar, the DL SAC Credential Preparation Course Instructor for course related

questions (e.g. content, dates, etc.) at sally@healthypeoplelearn.com or 585-396-2945.  

Can you participate in a class on:       Tuesday evenings - 7:30 pm - 9 pm        
                                                                Tuesday mornings - 9:30 am - 11 am     

Please indicate the start date of the class you are applying to participate in:   

 

Please submit application and any attachments to: SACCredential@nyssacc.org or Mail to:

 NYSSACC, c/o DL SAC Credential Program, 230 Washington Ave. Ext., Albany, New York 12203

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. By putting your name and date below, and submitting this form, you agree to the terms outlined above.

 Signature:   

Text Box: Distance Learning is no less demanding than traditional classroom based education, and requires significantly more self-motivation and time management skills. Distance Learning is NOT for everyone!!! The Distance Learning (DL) School Age Care (SAC) Preparation Course will meet live weekly, requiring simultaneous access to telephone and internet service. The days and times of these sessions will be determined at the first in-person class. These live sessions will be supplemented by independent online discussion amounting to 1-2 hours weekly. NYS EIP has approved this course as an eligible distance learning course. The cost of this course is $900.00 per 14 week semester, for a total course cost of $1,800.00. Travel and additional expenses for the in-person meetings are the responsibility of the individual student. If you are unable to attend the in-person meeting, please contact the instructor to make arrangements. Car pooling is encouraged, and class hours are scheduled top allow for reasonable round trip travel in the same day for most parts of the state. Candidate’s signature at the bottom of this form indicates their obligation to satisfy full payment for this class in the event they are not awarded EIP funds covering the full course cost. (EIP is not available for non NYS residents. Please contact us if you have questions about other funding streams in your state and whether we accept those forms of payment/vouchers.) Please note that your commitment to the required coursework and ability to complete online assignments, engage in online discussions and access to both the internet and email is essential. This is a demanding course, and we ask that you consider your ability to complete both semesters prior to applying. In addition, the assessment fee is now $1,000.00, with NYSSACC being the Credentialing Agency. EIP has also approved the $1,000.00 fee within their system. Refund Policy: Written requests for refunds need to be submitted to NYSSACC via email no later than thirty (30) days prior to the start of the class for a full refund. No partial refunds will be granted. Please feel free to contact NYSSACC at any time using the following methods. All financial related questions should be directed to NYSSACC – not the instructor:  Signature Date:

 

Please Print A Copy of This Form For Your Records Before Submitting.

 

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