APPLICATION & REQUIREMENTS
FOR: Tier II Credential & International Program
Calif. Tier I Credential (Preliminary Administrative Services Credential)
Desired but not required: 1+ year of administrative experience at time of program participation
FOR: International Leadership Program Only (no Tier II):
Six months experience in a leadership position in education
*Special Circumstances? Contact Dr. Orozco at: Lorozco14@yahoo.com
Non-refundable deposit of $500 due upon acceptance into the program and will be applied to International
Program fee of $1,100. Balance of $600 will be due prior to beginning online work, 4 months before travel.
___A. APPLICATION QUESTIONS- Cut and Paste the following questions and your answers into an
email and send to Dr. Orozco at: Lorozco14@yahoo.com
Which International Program?
____ Brazil OR ____ Thailand
1. Name (last, first, middle):
2. Cell # or best number to reach you:
3. Email Address:
4. Mailing Address with zip code:
5. Job Title:
8. Age: ___Under 30 ___30-39 ___40-49 ___over 50
9. Foreign languages you speak (conversational to fluent):
10. Ethnic or racial group with which you identify or 'decline to state':
11. Number of years you served as a teacher (counselor/nurse/librarian):
12. List Degrees/Credentials earned, year, with college(s)
13. How did you hear about program?
14. This innovative international program requires heightened levels of maturity, team building, self-discipline;
and acceptance of diversity, adventure & unpredictability. Briefly describe yourself in these areas.
15. Rio is a 'seductive city' of immense proportion, while Chaing Mai is much smaller, calmer but with an
historic charm and gateway to the 'golden triangle'. Although we take full advantage of sharing these
wonderful cities with candidates during our professional work; both offer temptations & distractions to the
enthusiast traveler. We have a limited number of seats & will be selective in putting our teams together.
Briefly describe your commitment to attend the entire program & participate fully in all professional activities
(questions 16-18 are for Tier II applicants):
16. Number of years/mos. serving as an Administrator (serving under your Tier I Preliminary Admin.
17. Year when your Tier I Credential expires:
18. Where did you complete the Tier I program (year) or test?
___B. CANDIDATES ACCEPTED INTO THE PROGRAM WILL BE PROVIDED
DIRECTIONS FOR PAYING THE $500 PROGRAM DEPOSIT.
NOTE: DEPOSIT IN NON-REFUNDABLE
CONTACT: Linda Orozco, Ph.D.
Telephone USA: (562) 368-4844
THANK YOU for your application to the International Program for School Leaders!