Induction Application Form
Butte Teacher Induction Program has partnered with Orange County Department of Education to offer a Teacher Induction Program for General Education (Multiple & Single Subject) and Education Specialist teachers who hold a preliminary credential and require Induction to obtain a Clear Teaching Credential. Please complete the application to apply to The Teacher Induction Program. Questions can be directed to Tracey Allen at 530-532-5730 or tallen@bcoe.org.
Candidate Information
Name (full legal name) *
Your answer
Maiden/Other Name:
Your answer
Home/Mailing Address: *
Your answer
City: *
Your answer
Zip Code: *
Your answer
Primary Email: *
Your answer
Secondary Email:
Your answer
Primary Phone Number: *
Your answer
Alternate Phone Number:
Your answer
Birthdate: *
MM
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DD
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YYYY
Credential Information
What program year are you applying to: *
Please indicate the type of credential you currently hold. *
Credential Document Number: *
Your answer
If you hold a Single Subject or Education Specialist: Other Credential, please indicate the subject area or specialty area.
Your answer
If you hold a second credential, please indicate the type of credential you currently hold.
If you hold a Single Subject or Education Specialist: Other Credential, please indicate the subject area or specialty area.
Your answer
Employment Information
County of Employment *
Your answer
District of Employment: *
Your answer
School: *
Your answer
School Address (street, city, zip): *
Your answer
Grade Level/Assignment Type: *
Your answer
Years of Teaching: *
Your answer
Principal/Site Administrator *
Your answer
Principal/S.A. Email: *
Your answer
Demographics
Demographic Information: *
Demographic Information: Race/Ethnicity (check all that apply) *
Required
Payment Information
Please select your payment option: *
If paying my own tuition, I understand that I am responsible for knowing when payments are due. If my payment is not made on time, further participation in the program may be denied and late fees will apply. Schools First Federal Credit Union offers loans to credit union members enrolled in our Induction program at low interest rates with several term options. For more information call 714-258-4000.
I understand that there is a $50.00 late fee for payments not received by the due date, and a $75.00 late fee for payments past due over 30 days.
I understand that my tuition must be paid in full before my records can be released to other programs, and/or before I can be recommended for my Clear credential.
In the event a district is paying my tuition, if they do not fulfill the payment requirements, I am responsible for paying my tuition in full.
If you are paying your tuition: I understand that by checking this box I must also include a non-refundable processing fee of $300.00 to secure my spot in the program. Please mail printed application and fee to: Butte Teacher Induction Program, Attn: Tracey Allen, 5 County Center Drive, Oroville, CA 95965 or contact us at 530-532-5802 for credit card payment option.
Please print this completed application for your records.
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