Early Educator Support, Licensure and Professional Development Unit (EESLPD)
ENROLLMENT & CHANGE FORM
NC Pre-K Teachers, Nonpublic Schools
INSTRUCTIONS & FORM
NC Pre-K lead teachers who work in nonpublic schools (Child Care centers and Head Start programs) are required to enroll with the EESLPD Unit. Teachers must hold one of the following degrees and/or teaching licenses. The Enrollment-Change form must be used to enroll or update your information. A Glossary of teacher education and licensure terms is attached.
· BA/BS degree in any field (attach or have college/university mail official transcripts) to be considered for a NC Lateral Entry B-K License
· NC Birth-through-Kindergarten (BK) or Preschool Add-on License (Standard I or II)
· Other NC Teaching License (field other than BK) or Another State’s License/Certificate
1. Complete the Enrollment-Change Form (page 2) - (A) Download the form to your desktop. (B) Type in the shaded fields. (C) Enter your legal name as it appears on your Social Security card. (D) Print and sign. (E) Attach required documents. (F) Give the packet to your site administrator to review and verify that all documents are complete and attached. (G) Submit your enrollment packet via certified mail to:
Early Educator Support, Licensure and Professional Development Unit
DHHS - Division of Child Development and Early Education
2201 Mail Service Center - Raleigh, NC 27699-2201
2. Please keep a copy for your records. Give a copy to your Site Administrator and to your local NC Pre-K Contact Administrator and/or NC Pre-K Program Contact. Your enrollment form will be processed when we receive all requested information and documentation.
3. Upon receipt of your Enrollment-Change Form, the EESLPD Unit will:
A. Confirm receipt of your enrollment and communicate instructions for next steps.
B. Determine and prioritize your eligibility and readiness status to participate in the
· Lateral Entry Teacher Program [LETP] - teachers without a B-K SPI or a SPII license
· Beginning Teacher Support Program [BTSP] - teachers with a B-K SPI, Preschool Add-On, or a Lateral Entry license
· Licensure Renewal Program - teachers with a B-K or Preschool Add-on SPII license
C. Inform you, your site administrator, and local NC Pre-K contractor about the required professional development series: Orientation and NC Teacher Evaluation Process Training, Developing Smart Goals and Your Professional Development Plan, and McREL Online Educator Evaluation System.
D. Facilitate the licensure application process, if you have less than a B-KSPII, or qualify for renewal or another licensure action.
E. Contact your higher education advisor, if you are currently working with a university to complete B-K licensure. Lateral Entry candidates (less than a B-KSP I) must provide their advisor’s contact information on the Enrollment-Change.
F. Provide mentoring support-supervision, conduct teacher observations and facilitate development of teacher Professional Development Plans based on licensure level.
Information about these programs, requirements and processes, will be discussed at orientation and posted on the DCDEE website in the near future. For assistance and questions, please contact Sharon Spigner at
Rev. 081611
EESLPD Enrollment Form Original Enrollment Changes to my information
NC Pre-K Teachers in Nonpublic Schools
Section I-NC Pre-K Teacher Information (tab from field to field)Write your full legal name as it appears on your Social Security card:
First Name: Middle Name: Last Name: Social Security Number:
Home Mailing Address: City: Zip Code: Date of Birth w/year:
Ethnicity: Black Native Hawaiian or Other Pacific Islander Asian American Indian or Alaska Native White
Hispanic? Yes No
Home Phone Number: Cell Phone Number:
E-Mail Address: County (residence location: )
Section II-Site Information (double click in check boxes and select “checked” under default value)
Are you employed in a Private Child Care Center Head Start Developmental Day? If yes, please complete Sections II, III, IV, and V. No. If no, please contact your Local Education Agency (school system).
Program Site Name: DCD Star Rating:
Site Administrator Name: Site County:
Site Physical Address: City: Zip Code:
Site Admin E-Mail Address: Site Phone Number: Site Fax:
Section III-Education and Licensure Information (B-K or Preschool Add-On License)
Degree: BA/BS MA/MS EdD/PhD Major:
University/College:
NC Teacher/Educator’s License? Yes (Attach a Copy) Other State’s Teacher’s License (Attach a Copy) No
If yes, have you completed a Beginning Teacher Support Program (BTSP)? Yes No
If yes, attach your most recent Teacher Evaluation Summary Rating Form and Professional Development Plan [PDP].
Section IV-B-K Licensure Status (Less than a B-K or Preschool Add-On License)
If you do not have a B-K License are you enrolled in an accredited B-K licensure Program with a College or University/ Institution of Higher Education (IHE)? Yes No
If yes, what is the name of the School: and IHE Advisor: Phone Number:
Are you affiliated with a NC Department of Public Instruction Regional Alternative Licensing Center (RALC)?
Yes No If yes, RALC Region: Site Coordinator: Phone Number:
Do you have a Plan of Study or Licensure Only Plan? Yes (attach a copy) No
If yes, have you completed all of the required coursework in your Plan of Study/Licensure Only Plan? Yes No
If no, how many semester credit hours do you need in order to complete your Plan of Study or Licensure Only Plan?
Do you currently have a T.E.A.C.H.® Scholarship? Yes No Are you receiving a WAGE$® Supplement? Yes No
Section V-Professional Development (Mandatory)
I have completed Foundations: Early Learning Standards (Training completed prior to January 2007 will be accepted.)
Yes Attach a copy of your certificate.
No Complete training at this link: http://www.earlylearning.nc.gov/Foundations/OnlineTrainingTool.asp
After you receive your certificate, please submit a copy to the EESLPD Unit.
Teacher’s Signature ______Date ______
Submitted to Site Administrator? ____Date Submitted to Local NC Pre-K Contractor? ____Date
Section VI-Site Administrator – Verification of Teacher’s Documents (Mandatory)
The NC Pre-K teacher’s Site Administrator is required to verify that all documents are included in the packet before the NC Pre-K teacher submits to the EESLPD. By initialing sections A and C or B and C, which correspond to the Enrollment-Change Form, the Site Administrator is verifying the NC Pre-K teacher’s enrollment or change form and supporting documents are complete. After the Site Administrator completes her/his review, the NC Pre-K Teacher should mail the packet via certified mail to Early Educator Support, Licensure and Professional Development Unit, DHHS - Division of Child Development and Early Education, 2201 Mail Service Center, Raleigh, NC 27699-2201.
Section A. Education and Licensure Information (Teachers who hold a B-K or Preschool Add-On License)
Subject / Document attached / Verification by Site Administrator
(initial if documents attached)
A. BA/BS degree in any field (attach original transcripts) / · Original transcript
B. Teacher’s License / · North Carolina or
· Other State’s Teacher’s License
C. Beginning Teacher Support Program (BTSP)? Only if teacher completed a BTSP program. / · Most recent Teacher Evaluation Summary Rating Form and
· Professional Development Plan
Section B. B-K Licensure Status (Less than a B-K or Preschool Add-On License- do not hold a B-K license)
Subject / Document attached / Verification by Site Administrator
(initial if documents attached)
A. Enrolled in an accredited B-K licensure Program with a College or University / · Plan of Study or
· Licensure Only Plan
C. Professional Development
Subject / Document attached / Verification by Site Administrator
(initial if document attached)
A. Foundations: Early Learning Standards / · Certificate for Foundations
I ______verify that I have reviewed the enrollment packet and all
Site Administrator’s Name– Please Print
required documents are attached. I understand if the packet is complete, the teacher will be placed on the EESLPD Unit wait list. Incomplete packets will be returned.
Mail all documents by certified mail to:
Early Educator Support, Licensure and Professional Development Unit
Division of Child Development and Early Education
2201 Mail Service Center
Raleigh, NC 27699-2201
Rev. 081611