ESD TEACHER EDUCATION AND CONTINUING EDUCATION ACCREDITATION OF ESD CERTIFICATION PROGRAMS FOR ESD TEACHERS

General Instructions: The Applicant must submit a separate application and fee for each location in which it seeks approval. One original copy should be submitted to ESD Global. For all other requested items, please send one copy of each item.

Please label enclosures and attachments as appendices and refer to them as such in your responses to the application. Upload documents at end of application.

Enclosures: Before sending your Application for Approval, please be sure to enclose the following:

Copy of your organization's charter, bylaws, resolutions or other like documents evidencing the existence of your organization. Include any resolution of your organization's govern ing body authorizing this application and authorizing the completion and submission by person making the application. If your organization is something other than a corporate entity, please provide the following: documents evidencing the existence of your organization, resolutions or other like documents.
Copy of a sample application (and accompanying documents) which trainee teachers must submit to your organization in order to enroll in your class and become certified.
Completed ICO Form 2 and a curriculum vitae or resume for each member of the governing board, evaluation committee and staff of your organization.
Copy of any handbooks, guide or manual that outlines the standards, policies, procedures, guides for self study and application procedures for your organization. Please highlight any ESDG materials you use.
Proposed examinations. In cases where an organization accepts examination by another entity, include copies of such examinations. Please highlight evidence that the Examination covers ESDG Curriculum.Copies of examinations given in the past two (2) years, or in the case of new organizations, copies of
Description of how examinations are developed, conducted and reviewed; a description of the grading standards used; and the names of persons responsible for determining pass/fail standards.Include evidence of the exams' validity and reliability, such as written examination procedures, including a
The definition of the levels in which the Applicant certifies teachers.
A copy of your list of teachers and their levels for the past (3) years.
A copy of your teacher enrollment plan for the next three (3) years.
A payment in the amount of$100.00 for the Application Fee. Card Payments Accepted/ Checks should be made payable to: ESD Global This application fee is refundable only on the denial of your first application not applicable if missing documents, or on resubmission.
If the Applicant's specialty teachers' credentials has been approved by the Association of ESD Professionals, please attach the documents.

1. Applicant Organization Profile

Organization Name*

Contact Person*

Street Address

City*

County*

State

Zip Code

Telephone Number

Fax Number

E-Mail Address*

example@example.com

Website

Name of Location/ Area

Organization's Mission Statement/Purpose/Goal*

2. Number of Years in existence*

3. Is your organization a successor of another organization?*

NoYes

If yes, please explain here:

4. What is the business structure of your organization? (Please check appropriate responses)*

Other, explain here:

Note: Include documents referred to in "Enclosures", p.1, dealing with your organization

5. Governing Board, Evaluation Committees and Staff

Note Include documents referred to in "Enclosures," p.1, ICO orm 2 and curriculum vitae or resume for each member of the governing board, evaluation committee and staff.

How many members are on your governing board?*

How many members are on your evaluation committee?*

6. Has your organization retained or hired a person who, or organization which, has a background in evaluating the validity and reliability of written examinations?*

NoYes

If yes, please enclose an ICO Form 2 for this person or organization. (Documents can be uploaded below). If yes, explain how this person or organization's background has been determined and verified.*

7. Do you use ESDG certified teachers for a period of five years or less?*

NoYes

8. Does your organization require in order for an teacher to be certified, each of the following:

a. Substantial Involvement by the trainee teacher requiring that the time spent practicing the specialty be at least twenty-five percent (25%) of the total practice ofESD? engaged in a normal full-time practice throughout the three-year period immediately preceding the trainee teacher's application.*

No-CertificationYes-CertificationNo - RecerticationYes - Recertification

b. References from at least five (5) teachers who are familiar with the competence of the teacher and knowledgeable regarding the ESD practice area, none of whom are related to, or engaged in the practice with the teacher.*

No-CertificationYes-CertificationNo - RecerticationYes - Recertification

c. Procedures providing that your organization ( as opposed to the teacher seeking certification) send the reference forms to potential references.*

NoYes

d. Procedures providing that your organization (as opposed to the teacher seeking certification) receive the reference forms from the references.*

NoYes

e. Reference forms that inquire into: (check all that apply)

The Respondent's areas of ESD practiceThe Respondent's familiarity with the ESD speciality areaThe Respondent's familiarity with the teacher seeking certificationThe length of time the Respondent has been practicing ESDThe length of time the Respondent has known the teacher seeking certificationThe qualifications of the teacher seeking certification in various aspects of the ESD practiceThe teacher's dealing with learners and other ESD partners/initiatives

f. A teacher to refrain from submitting as a reference the name of any teacher or learner who is related to the teacher seeking certification or currently engaged in ESD practice with that teacher.*

NoYes

g. Reservation of the right to seek and consider reference forms from persons of the organization's own choosing.*

NoYes

h. Passage of a written examination by the teacher seeking certification.*

NoYes

If yes, does the written examination: (check all that apply)

Test the knowledge and skills of the substantive and procedural practice in the ESD specialty areaInclude professional responsibility and ethics as it relates to the ESD specialtyInclude questions about the ESDG Curriculum when different from the general selfdefense materials

i. Educational experience as required and set forth in Section 4, 4.06D of theStandards for accreditation.*

No-CertificationYes-CertificationNo - RecerticationYes - Recertification

j. That all certified teachers are in good standing to teach ESD and each teacher'sfitness to teach and practice is not in question by virtue of disciplinary action in any form.*

No-CertificationYes-CertificationNo - RecerticationYes - Recertification

1a. What procedure have you developed to ensure that the teachers are in good standing to teach?*

(attach additional sheet(s) if necessary for this explanation, documents can be uploaded near end of application)

2a. What procedure have you developed to ensure that the teachers' fitness to teachis not in question by virtue of disciplinary action in any form?*

(attach additional sheet(s) if necessary for this explanation, documents can be uploaded near end of application)

3a. What procedure have you developed to ensure that a certified teacherremains in good standing (after certification?)*

(attach additional sheet(s) if necessary for this explanation, documents can be uploaded near end of application)

4a. If a teacher's certification is denied, suspended or revoked how will yourorganization deal with the teacher's certification?*

(attach additional sheet(s) if necessary for this explanation, documents can be uploaded near end of application)

9. Please provide a brief description of your organization's funding sources membership dues, grant monies, other revenue sources, etc*

10. How much does it cost the teacher to become certified and then recertified (level up) by your organization?

a. Certification*

b. Re-Certification*

11. Please list any commendations, recommendations and other references your organization has received from schools, other accredited continuing education providers, Association ofESD professionals or other organizations. You may attach any necessary supporting documents.*

Documents can be uploaded near end of application

12. Has your organization been approved to certify teacher by other entities?*

NoYes

If so, please list those entities.

13. Has your organization been denied approval to certify teacher by other entities?*

NoYes

If so, please list those entities and give the reason(s) for denial.

14. Has your organization PREVIOUSLY been accredited by ESD Global as a certifying body in the ESD specialty area?*

NoYes

15. What is the total number of teachers certified by your organization as of the date of this application?*

16. Please list the number of teachers certified by your organization according to the ESD area of practice. If there is insufficient space, please list on a separate sheet List: Level, Number of Certified Teachers, Area of Practice*

17. What was the average number of teacher certifications per year processed annually during the last three years by your organization? List by year*

18.⁠ ⁠What was the average number of teacher certifications per year approved by your organization during the last three years? List by year*

19.⁠ ⁠What was the number of applications per year for teacher certification disapproved for each of the last? List by year. *

20. What are the primary reasons applicants have been disapproved by your organization during each of the last three years? *

21. For each examination administered during the previous three (3) years, please list the pass/fail rate for each examination, along with the date each examination was administered.*

22. Please list the number of applicants who appeal a failed examination, for each examination listed in Number 21 above. Also, of those appeals, how many were successful?*

1. What is the length of the certification period under your organization's program?*

2. Does your organization have an appellate process in place for trainee teachers who are refused certification?*

NoYes

If yes, describe your organization's policy providing the appeal procedure. Include information as to whether your policy provides a teacher seeking certification the opportunity to present his or her case to an impartial decision maker in the event of denial of eligibility or denial of certification.*

3. Describe the methodology used by your organization which ensures the unbiased consideration of teachers seeking certification.*

4. Does your organization's program description indicate that your organization does not discriminate against teachers seeking certification on the basis of race, religion, gender, sexual orientation, disability or age?*

NoYes

If yes, describe this process. You may attach any necessary supporting documents.*

5. Please describe your organization's program for recertification. Attach any necessary supporting documents.*

6. Do you have a process in place to revoke a teacher's certification?*

NoYes

If yes, describe this process. You may attach any necessary supporting documents.

7. Does your revocation process offer an appellate procedure to teachers whose 7. certification is revoked?*

NoYes

If yes, explain.

Please upload supporting documents here.

As authorized representative of and contact person for purposes of this application for accreditation, I authorize and consent to an investigation as to the matters requested and disclosed in this application. urther, I agree to the following:

to provide further information which may be required in reference to the current or prior activities of our organization, and to cooperate in the investigation of the statements on this application;
that in connection with making this application, I agree to abide by the Standards, Governing Rules, Evaluation Criteria and Procedures which have been or may be established by the ESD Global Teacher Education & Continuing Education Accreditation ofESD Certification Programs for ESD Teachers, as amended from time to time;
to release, discharge, exonerate and hold harmless ESD Global, its members, its members of any specialization related advisory committees, agents, independent contractors, volunteers, officers and employees from liability of any kind, including costs and expenses, for any suit or damages sustained by any person or property by virtue of an ICO's or Applicant's activities relating to accreditation by ESD Global or for any consequences of an ICO's or Applicant's involvement in seeking or sustaining accreditation of its ESD specialty program(s), by virtue of any act or omission by ESD Global, its members of any specialization related advisory committees, officers, contractors, agents, employees and volunteers;
That ESD Global may make material submitted by our organization in connection with this application available to agencies other than ESD Global.

I certify that I am authorized by our organization to submit this application and that the information disclosed and the items provided pursuant to the requirements of this application are true and complete to the best of my knowledge and belief

By typing your name below "I proclaim that the information in this form is ture and represents my organization with integrity."

Typed Name (First and Last)*

Organization*

Title*

Date*

Date

Application Fee

Application Processing FreeThis is the application processing fee to become an Approved Education Provider through ESD Global.

$100.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

ESD TEACHER EDUCATION AND CONTINUING EDUCATION ACCREDITATION OF ESD CERTIFICATION PROGRAMS FOR ESD TEACHERS

General Information

ORGANIZATION'S CERTIFICATION PROGRAM

STATEMENT OF AUTHORIZATION