Maryland Credentialing Application PDF Details

The Maryland Credentialing Application Form is a form that healthcare professionals in the state of Maryland must complete to be credentialed by specified organizations. The form requests information about the applicant's professional qualifications, work history, and other relevant information. The deadline for submitting the application is typically within 30 days of beginning work at a new facility. Completing the Maryland Credentialing Application Form can be a time-consuming process, but it's important to ensure that all of the required information is included. Incomplete or inaccurate applications may lead to delays in being credentialed or even denied credentialing altogether. Make sure to allow plenty of time to complete the application so that there are no surprises down the road.

If you would like first understand how much time you will need to fill out the maryland credentialing application and the number of pages it has, here's some general information that may b

QuestionAnswer
Form NameMaryland Credentialing Application
Form Length3 pages
Fillable?Yes
Fillable fields95
Avg. time to fill out19 min 49 sec
Other namesmaryland credential upgrade forms, md credentialing application, sample credentialing letters to applicant, how to maryland credentialing

Form Preview Example

Fax:

Maryland State Department of Education/Division of

Return To:

410-229-0145

Early Childhood Development

Child Care Central

Email:

Maryland Child Care Credential Program

PO Box 598

cccredential@conduent.com

CREDENTIAL APPLICATION

Baltimore, MD 21203

 

 

 

** Instructions for each section of this application are at the end of the application, on page 3. **

Incomplete applications will be returned.

For assistance completing the application, call Child Care Central at 1-877-355-1229 or refer to the Credentialing Booklet at

http://earlychildhood.marylandpublicschools.org/child-care-providers/credentialing

 

 

Section 1

 

General Information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Application Type:

First Application

Renewal

Update

Upgrade

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section 2

 

Applicant Information

 

 

 

 

 

 

 

 

Name (Last, First, Middle, Maiden):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Party ID Number:

 

Social Security Number (SSN):

 

 

Date of Birth (DOB): MM/DD/YYYY

 

 

 

 

 

 

 

 

 

 

 

Gender: Female

 

Race and Ethnicity: White or Caucasian

 

Age Range: 17-35

 

 

 

Male

 

 

Black or African American

 

 

36-54

 

 

 

Non-binary

 

 

Hispanic or Latino

 

 

55 - above

 

 

 

 

 

 

 

 

Asian or Asian American

 

 

 

 

 

 

 

 

 

 

 

American Indian or Alaska Native

 

 

 

 

 

 

 

 

 

 

 

Native Hawaiian or other Pacific Islander

 

 

 

 

 

 

 

 

 

 

Another Race

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Primary Language:

 

 

 

 

County/Jurisdiction:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address:

Street

Apt Number

City

State

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

Phone Number:

 

 

 

Email Address:

 

 

 

 

 

 

 

 

 

 

Are you currently enrolled in the Child Care Career Professional Development Fund (CCCPDF)? Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section 3

 

Employment Information

 

 

 

 

 

 

 

 

Licensed Child Care Center Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address:

Street

Apt Number

City

State

Zip Code

 

 

 

 

 

 

 

 

 

 

 

Center License Number:

 

 

Center Phone Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Family Child Care Provider Registration Number:

________________________

Child Care Center Employee (Check primary position.)

Director Teacher Aide Other ______________________

Age Group (Check all that apply.):

Infant/Toddler Preschool School Age All

Section 4 Essay

Include an essay only if this is a First Application. The essay is not required for Renewal, Update, or Upgrade Applications.

The Credential Essay is designed to enable the applicant to reflect thoughtfully on his/her career as an early childhood educator and/or administrator. Reflection allows child care professionals to “paint a picture” of current practice and focus on improving skills and knowledge. As a professional it is necessary to reflect on your practices and interactions with children and families. Reflection can result in opportunities for continuous improvement of practice and skills. Stop and take time to reflect daily as you interact with children and families. Listen openly to the ideas of others. Reflect on your work and the work of others around you. Consider and implement ways to develop your practice.

Choose one question as the topic of your essay. Include your essay in your application packet. Your essay should be 300 to 500 words and may be typed or handwritten.

Why did you become a child care professional?

Why do you want to get the Maryland Child Care Credential?

DOC.111.11 Revised 01/22. All previous versions are obsolete.

Page 1 of 3

 

Section 5

Signature

 

 

 

 

 

I affirm that all information on this application and all attached documentation is true and correct. I understand that if I have had a child care license or registration suspended or revoked I may not be eligible to participate in the Credential Program. I further understand that there are penalties for giving false statements. I have attached all required information including documentation of training, professional activity, and experience. My signature below makes this statement binding.

Applicant Signature

Date

This application will not be processed if the form is not signed and dated.

 

Section 6

Education

 

 

 

 

 

List all courses from your attached college grade slips/transcripts that are related to early childhood development and the college credit hours for each.

If this is a First Application, list all related college courses ever completed.

If this is a Renewal, Update, or Upgrade, list only related college couses taken during the current credential year.

Course Title

College Credit Hours

DOC.111.11 Revised 01/22. All previous versions are obsolete.

Page 2 of 3

Instructions for completing an

application to the Maryland Child Care Credential Program

Section 1 General Information

Select only one Application Type.

To be credentialed for the first time, check First Application and complete Sections 1 through 6.

To renew a current credential within the required timeframe, check Renewal and complete all Sections except Section 4. To reactivate a credential that expired more than 30 days ago, check Update and complete all Sections except Section 4. To move to a higher level within the credential year, check Upgrade and complete all Sections except Section 4.

Required Documentation

Enclose the following documents with your application.

 

 OCC Approved Training Certificates (Completed within 5 years of application date for First Application.

 

 

Completed within the current credential year for Renewal, Update, or Upgrade.)

Education/Training

 College grade slips/transcripts or proof of current college enrollment (No expiration regardless of datefor

 

First Application. Completed within the current credential year for Renewal, Update, or Upgrade.)

 

 

 

 College degree with accompanying transcript from an accredited college or university. (Foreign degrees

 

 

must be translated and evaluated before submission.)

 

 

Professional Activities

 Professional organization membership card(s)

Canceled checks

(Must be within 12 months

 Letters of acknowledgement of participation in professional activities

of application date.)

 Other documentation, as appropriate.(Refer to the Credential Program booklet for examples of PAUs)

 

 

 

 

 Family Child Care Provider: Copy of any family day care certificate of registration, including current

 

 

certificate and copy of at least one child attendance sheet completed during the past 12 month period.

Experience

Center Staff: Letter of employment on center letterhead including position, hours worked per week and

 

 

start and end date for each position held or other documentation of current employment.

Any other documentation of experience, letters, time sheets, staff evaluation card, etc.

Section 2 Applicant Information

Answer all of the questions in this section.

Please make a note of the Date of Birth and Phone Number you enter on the form. This information will be needed to access your credential information on the automated phone system.

Section 3 Employment Information

Answer all of the questions in this section for your current position. In the Position field, choose either Family Child Care Provider or Child Care Center Employee. If you are an employee, answer the remaining questions in that section.

Family child care providers must submit a certificate of registration and 1 attendance sheet dated within the last 12 months. Child care center staff must submit a letter of employment on the center's letterhead including position, hours worked per week and start and end date for each position held.

Section 4

Essay

 

 

If this is your first application, either type or hand write an essay on the question you selected and include it in your application packet.

Section 5

You must sign and date the application for it to be considered complete. Incomplete applications will be returned.

Section 6

Education

 

 

List all courses from your attached college grade slips/transcripts that are related to early childhood development and the college credit hours for each. If this is a First Application, list all related college courses ever completed. If this is a Renewal, Update, or Upgrade, list only related college courses taken during the current credential year.

Additional Information

For additional information on the Maryland Child Care Credential Program or completing this application refer to the Credentialing Booklet at http://earlychildhood.marylandpublicschools.org/child-care-providers/credentialing.

DOC.111.11 Revised 01/22. All previous versions are obsolete.

Page 3 of 3

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