Cal. Code Regs. Tit. 5, div. 4, ch. 1, art. 14, att. C.4

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Current through Register 2025 Notice Reg. No. 2, January 10, 2025

Attachment C.4

FORM IS OPTIONAL - INFORMATION IS STILL REQUIRED FOR APPLICATION PROCESS

2xxx-xx APLE for District Interns Application and Selection Summary Sheet

To be completed by the APLE for District Interns Coordinator. Please submit by November 30, 2xxx.

1. Indicate the number of district interns who competed for the 2xxx-xx APLE: ______________________________

2. Indicate the number of district interns who met your program's selection criteria: ______________________________

3. Indicate the number of district interns who were selected as applicants: ______________________________

Be sure to list all selected applicants on page 6 and attach a complete application for each person.

4. To help determine the number of reallocation applicants, indicate the number of applicants who were listed in Item #2 above, but not included in Item #3, (i.e. subtract #3 from #2) and record here. __________

5. Based on the figure you provided in item #4 -

List the applicants on the Reallocation Selection and Summary Sheet (G-171R), and attach the applications or required application information to the form.

6. Indicate the criteria your program used in selecting applicants: (Check all that apply)

__________ Test Scores	__________ Faculty Recommendation	Other (specify)
__________ Interview	__________ Extra Curricular	___________________________
__________ Essay	__________ Volunteer Work	___________________________
__________ Grade Point Average (GPA)

7. If your program uses the GPA as a selection criterion, please indicate the cutoff GPA score: __________

*By my signature,*
.	*I am enclosing an APLE for District Intern Application* and LAA for each applicant.**
.	I have verified that each applicant meets the program eligibility requirements.
.	I have verified that the applicants' academic majors and the credential objectives are compatible with their designated teaching subject areas.
.	I understand that these applications and LAA's will undergo further review by the California Student Aid Commission and only those applicants who meet all program requirements will be permitted to participate in APLE for District Intern.
___________________________
	School Name

___________________________			___________________________
	Signature			Title

___________________________			___________________________
	Print Name			Email Address

___________________________			___________________________
	Telephone Number	(Ext.)		Date

Please return this information and the application information to:

CALIFORNIA STUDENT AID COMMISSION

ATTN: SPECIALIZED PROGRAMS OPERATIONS BRANCH

P.O. BOX 419029

RANCHO CORDOVA, CA 95741-9029

Cal. Code Regs. Tit. 5, div. 4, ch. 1, art. 14, att. C.4