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1
School District CODE
Units
LEA/ECE site supervisor
LEA/ECE site supervisor credential match
Student Name
Semester
Instructor NameSchool DistrictSchool SiteCourseSectionCourse DescriptionNumber of hoursGrade BandEmployment-based Waiver for 200 PK-TK hoursPracticum-based Waiver for PK-TK hours
2
43693934 or 10Teacher nameMS Clear CredentialStudent nameFall 2024Instructor nameCampbell UnionSchool name143A or 143B1, 2 etcPhase I or 2 Stdt-Teach200 or 400PK-TK or K-3# of hours (0 or 200)# of hours
3
CDP Site Supervisor permit
4
5
6
7
8
9
10
11
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14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100