CSI3 CREDENTIAL PROGRAM Handbook 2020-UPDATED

CSI3 CREDENTIAL

PROGRAM FORMS AND POLICIES

2020
STAR | REAL | TTT

CA STEM INSTITUTE FOR INNOVATION AND IMPROVEMENT
CALIFORNIA STATE UNIVERSITY DOMINGUEZ HILLS

MEETCRYEODUERNTIAL TEAM
Welcome! We look forward to working with you on your journey to become an amazing TEACHER!

DR. KAMAL HAMDAN XIOMARA BENITEZ, M.A.
Executive Director Director of Operations

E: [email protected]
P: 310.243.2536

LAURA AVENDANO, M.A. JESSICA RENTERIA, M.A.
Director of STEM Education Director of Elementary
and Teacher Development Education
E: [email protected] E: [email protected]
P: 310.243.2467 P: 310.243.3288

ASHLEY DESTER, M.A. KAREN VALLE
Secondary English Teacher Residency Programs
Support Coordinator Coordinator
E: [email protected] E: [email protected]
P: 310.243.2877 P: 310.243.3073

STEPHANIE ESTRADA ARNIE POSADAS
Credential Recruitment IT Support Specialist
and Selection Specialist E: [email protected]
E: [email protected] P: 310.243.3251
P: 310.243.2668

TABLE OCOF NTENTS

1 MEET YOUR CREDENTIAL TEAM
2 PROGRAM EXPECTATIONS
3 REAL PROMISSORY NOTE
4 STAR PROMISSORY NOTE
5 MSTI | TTT SERVICE AGREEMENT
6 CSUDH ACADEMIC CALENDAR (2019-2021)
7 STIPEND CERTIFICATION AND PAYMENT REQUEST
8 VENDOR DATA
9 DIRECT DEPOSIT AUTHORIZATION
10 LAUSD SCHOOL CALENDAR (2020-2021)
11 QUICK RESOURCE GUIDE

12 CANDIDATE DISCLOSURE RELEASE FORM
13 AUDIO/ VISUAL RELEASE FORM

CENTER FOR INNOVATION FOR STEM EDUCATION, CISE
CA STEM INSTITUTE FOR INNOVATION AND IMPROVEMENT, CSI3

PHONE: (310) 243-2634 | www.csi3.org

CA STEM INSTITUTE FOR INNOVATION AND IMPROVEMENT, CSI3
CREDENTIAL PROGRAM EXPECTATIONS FOR SUCCESS

REAL | STAR | TTT

Your success is important to us. CSI3 Teachers represent CSI3, not only in their credential coursework,
but in the university, their schools, and the communities that they serve. Therefore, they are always
expected to perform at the highest level of academic and professional excellence. Achieving
excellence will always be the goal of the CSI3 programs. CSI3 participants are expected to reach this
level of excellence and comply with the following expectations in order to ensure a quality educational
experience.

I. Professional Expectations

a. Possess a positive attitude towards teaching.
b. Appreciate diversity within a community and understand how differences in background and

interest contribute to a positive multicultural environment.
c. Act and dress professionally.
d. Be on time and be prepared to observe/teach.
e. Accept constructive feedback and consider new ideas.

II. Academic Expectations

a. Possess a positive attitude towards learning.
b. Be prepared for and actively participate in each class session.
c. Attend every class session. In case of emergency, students must notify the instructor and

Ms. Karen Valle at [email protected] for absences or late arrivals. This is mandatory.
i. Due to the accelerated nature of this program, if a participant misses more than
one class session per class per semester, the participant will be placed on
probation. If the student fails to meet these conditions, the participant will be
dismissed from the program. Participants on probation are ineligible to continue
to receive any stipends.

d. Arrive before the starting time and remain until the class is dismissed.
e. Be respectful to their fellow students and to course Instructors.
f. Remember to turn off cell phones and all communication devices while in class.
g. Use laptops/computers in class for the sole purpose of course-related activities.

III. Lab School and Teacher Support Institute (TSI) Expectations
a. Attend ALL STEAM Lab School sessions. In case of an emergency, please contact Ms. Laura
Avendano at [email protected]. Participants may not miss more than two (2) sessions per
term. Missing more than two (2) sessions or not notifying the program may be grounds for
program suspension.
b. Attend ALL required Teacher Support Institute (TSI) Sessions. In case of an emergency, please
contact Ms. Ashley Dester at [email protected]. Missing more than the minimum required
sessions or not notifying the program may be grounds for program suspension.

IV. Program Expectations
a. CSI3 Participants should check their e-mail and the CSI3 Google Classroom frequently as this
is the program’s main form of communication. If a student is unavailable to check e-mail or
Google Classroom, they should call the program office to check for announcements.
b. CSI3 Participants should register and pay for tuition on time or be dropped from courses
by the university.
c. CSI3 Participants must attend all CSI3-related activities.
d. CSI3 Participants should have a copy of the catalog and keep a file of correspondence and
documents sent to and received from the University (keep a copy of everything).
e. The CSI3 Programs will be evaluated throughout the year, and participants will be asked to
complete questionnaires. Your opinion counts, so be sure to honestly evaluate your experience.
We need your constructive feedback.

Remember, your success is important to us. Our mission is to support our CSI3 Participants. We take
serving our CSI3 Teachers very seriously. Help us serve you best by adhering to these expectations. If
you have any questions, comments, or concerns, please do not hesitate to contact the CSI3 Office.

I have read and agree to the aforementioned terms and expectations.

Participant (Printed) Name: _________________________________ ________________________

Participant Signature: _____ __________________________ Date: ________________________

Original kept with the CSI3 Office.

Last Updated 05/06/20

RESIDENCY FOR EQUITY THROUGH ACTION AND LEARNING, REAL

PROMISSORY NOTE

Center for Innovation in STEM Education, CISE Page 1 of 4
California STEM Institute for Innovation & Improvement, CSI3

Residency for Equity through Action and Learning, REAL
1000 East Victoria Street | Carson, CA 90747
Phone (310) 243.2634

The Residency for Equity through Action and Learning, REAL Program
is funded by a grant from the U.S. Department of Education.

Last Updated: 05/06/20

U.S. DEPARTMENT OF EDUCATION
California State University Dominguez Hills (CSUDH)
Residency for Equity through Action and Learning (REAL) Program

A grant from the United States Department of Education makes it possible for CSUDH Foundation
(“University”) to provide a REAL stipend of up to $24,000 to individuals who have been admitted to
the program, leading to a preliminary teaching credential and a Master’s degree.

Letter of Agreement and Promissory Note

I, the undersigned “Recipient” for value received, understand and agree that unless I
fulfill the terms and conditions of this Letter of Agreement and Promissory Note, which I have
entered into with the Residency for Equity through Action and Learning (REAL) Program
and the University Foundation, I am obligated to repay the principal sum (“Stipend”) of up to $24,000
together with any and all charges that may become due as provided in this Letter of Agreement and
Promissory Note. These charges include but are not limited to classroom supplies, books, and equipment.

I understand that the distribution of the grant is as follows: participants in the REAL program
will receive a $24,000 stipend in monthly installments (to be determined by the program).

SECTION I – PREREQUISITE REQUIREMENTS

In order to be eligible for the REAL stipend, I must:
1. Not be in default on any Federal Student Loan.
2. Be a REAL program participant enrolled full-time in the teacher credential program.
3. Attend REAL pre-program activities.
4. Meet the basic skills requirement (through passing CBEST, ACT, or SAT scores).
5. Pass the CSET exam or be eligible for the SMPP waiver.

SECTION II – COURSE WORK REQUIREMENTS

I understand that to retain eligibility to participate in the University’s REAL Program, I must:

1. Be continuously enrolled in the credential program and graduate education/Master’s
program at CSUDH as a full time student in the REAL program and maintain satisfactory
academic progress in the program, including but not limited to earning grades of no less
than a “B” in all education course work. These standards are described in the University
catalog.

2. Complete coursework and training necessary to obtain a teaching credential and Master’s
degree.

3. Attend ALL required STEAM Lab School sessions [refer to “CSI3 Credential Program
Expectations” for more details].

4. Attend ALL required Teacher Support Institute Sessions [refer to “CSI3 Credential Program
Expectations” for more details].

5. Agree that failure to comply with items 1,2,3, or 4 of Section II will result in ineligibility for
the program. If I become ineligible, the stipend funds will be reversed (refunded) to the
REAL program. After the stipend is reversed, I will be responsible for paying all institutional
charges (tuition, fees, etc.) in relation to the Institutional Refund Policy, as stated in the
University Catalog.

Last Updated: 05/06/20 Page 2 of 4

SECTION III – TEACHING COMMITMENT

I must:
1. Successfully complete one year of residency at a high-need partner school.
2. Teach on a full-time basis for a minimum of four (4) years, not including the residency year,
in an approved Green Dot Public School, high-need partner school, as defined by 20 US
6682 (3).
3. Begin the first school year of eligible full-time teaching service in an approved Green Dot
Public School, high-need partner school from the date I qualify for a preliminary teaching
credential and secure a teaching position.
4. Perform consecutive teaching years once I begin my teaching service until my obligation is
fulfilled.
5. Must adhere to the Professional Standards as stated in the CSI3 Credential Program
Expectations (signed by participant).
6. Provide any required employment verification establishing compliance with the above
requirements.
7. Agree that failure to comply with any item (1, 2, 3, 4, 5 OR 6) of Section III will result in a
requirement to repay the Stipend funds received.

SECTION IV –PROGRAM WITHDRAWAL

If I am unable to meet the course requirements or teaching commitment or choose to withdraw from
the program due to personal reasons, I will:

1. Immediately notify the REAL Program Coordinator in writing of my decision to withdraw.
2. Schedule an exit conference with the REAL Program Coordinator and the Director of STEM

Education and Teacher Development or Director of Operations within twenty-one (21) days
of notifying the REAL Program Coordinator of my decision to withdraw from the Program.
3. Receive repayment letter from program coordinator with further instructions following the
exit conference with the REAL Program Coordinator and the Director of STEM Education and
Teacher Development or Director of Operations.

SECTION V –REPAYMENT OBLIGATION

If I fail to meet the course requirements, to complete my teaching commitment, and/or withdraw
from the program, I shall:

1. Repay the amount of the Stipend award received to CSUDH Foundation.
2. Set up a repayment schedule if I am unable to repay the entire amount within 30 days of

withdrawal date.
3. Make payments to the REAL program according to the schedule established by the

program, which requires complete repayment within three (3) months after I enter
repayment status.
4. Agree that if I fail to repay the Stipend as stated in this Agreement, I will have to pay
reasonable collection costs, including but not limited to attorney’s fees, court costs and other
fees.

Last Updated: 05/06/20 Page 3 of 4

SECTION VI – ADDITIONAL REQUIREMENTS

I must:
1. Respond to all communications and requests from the REAL program and the University
Foundation within the time indicated.
2. Provide written notification to the REAL program and the University Foundation within
twenty-one (21) days of any change in my legal name or address or of any change in the
status affecting my eligibility.
3. Comply with any procedures deemed necessary and appropriate by the REAL program and
the University Foundation, all conditions cited in this Agreement, and all applicable rules and
regulations.

SECTION VII – APPEALS

Once I have been accepted to participate in the program, I may appeal any determination of non-
compliance within any provisions of the program in the following manner:

1. Provide a written notice of appeal, which includes a concise statement of the action being
challenged.

2. The notice of appeal must be postmarked within twenty (20) calendar days from the date
of the REAL program’s letter stating the decision being challenged.

3. Direct appeals shall be sent to the following individuals, in the following order:
(a) The Program Coordinator
(b) The CSI3 Executive Director

SECTION VIII – TAXES

This Grant may have tax consequences. Please consult with your tax professional.

SECTION IX – LEGISLATIVE ACTION

If the statutory authority for the Residency for Equity through Action and Learning, REAL Program,
including authority for funding, is repealed, amended, or significantly modified, either by legislative
action or the administrative action of the federal agency that administers the Residency for Equity
through Action and Learning Program, the University Foundation may modify this Agreement
accordingly. In such event, the REAL program will provide written notification of such changes.

I authorize the release of information pertinent to my Stipend by the REAL program and the
University Foundation or their agents, the U.S. Department of Education or any other party involved
in the administration of my Stipend or the terms identified in this Agreement. By my signature, I
acknowledge that I have read and understand the above information and that I am required to
fulfill my teaching obligation according to the terms and conditions herein.

Name (Printed) _______________________________ Phone Number ____________________

Signature ________________________________________ Date: ______________________

Permanent Address______________________________________________________________

Original kept with the CSI3 Office.

Last Updated: 05/06/20 Page 4 of 4

STEM TEACHERS IN ADVANCED RESIDENCY, STAR
PROMISSORY NOTE

Center for Innovation in STEM Education, CISE Page 1 of 4
California STEM Institute for Innovation & Improvement, CSI3

STEM Teachers in Advanced Residency, STAR
1000 East Victoria Street | Carson, CA 90747

Phone (310) 243.2634

The STEM Teachers in Advanced Residency, STAR Program
is funded by a grant from the U.S. Department of Education.

Last Updated: 05/06/20

U.S. DEPARTMENT OF EDUCATION
California State University Dominguez Hills (CSUDH)
STEM Teachers in Advanced Residency (STAR) Program

A grant from the United States Department of Education makes it possible for CSUDH Foundation
(“University”) to provide a STAR stipend of up to $30,000 to individuals who have been admitted
to the program, leading to a preliminary teaching credential and a Master’s degree.

Letter of Agreement and Promissory Note

I, the undersigned “Recipient” for value received, understand and agree that unless I
fulfill the terms and conditions of this Letter of Agreement and Promissory Note, which I have
entered into with the STEM Teachers in Advanced Residency (STAR) Program and
the University Foundation, I am obligated to repay the principal sum (“Stipend”) of up to $30,000
together with any and all charges that may become due as provided in this Letter of Agreement and
Promissory Note. These charges include but are not limited to classroom supplies, books, and equipment.

I understand that the distribution of the grant is as follows: participants in the STAR program
will receive a $30,000 stipend in monthly installments (to be determined by the program).

SECTION I – PREREQUISITE REQUIREMENTS

In order to be eligible for the STAR stipend, I must:
1. Not be in default on any Federal Student Loan.
2. Be a STAR program participant enrolled full-time in the teacher credential program.
3. Attend STAR pre-program activities.
4. Meet the basic skills requirement (through passing CBEST, ACT, or SAT scores).
5. Pass the CSET exam or be eligible for the SMPP waiver.

SECTION II – COURSE WORK REQUIREMENTS

I understand that to retain eligibility to participate in the University’s STAR Program, I must:

1. Be continuously enrolled in the credential program and graduate education/Master’s
program at CSUDH as a full time student in the STAR program and maintain satisfactory
academic progress in the program, including but not limited to earning grades of no less
than a “B” in all education course work. These standards are described in the University
catalog.

2. Complete coursework and training necessary to obtain a teaching credential and Master’s
degree.

3. Attend ALL required STEAM Lab School sessions [refer to “CSI3 Credential Program
Expectations” for more details].

4. Attend ALL required Teacher Support Institute Sessions [refer to “CSI3 Credential Program
Expectations” for more details].

5. Successfully participate in one semester of internship.
6. Agree that failure to comply with items 1,2,3,4, or 5 of Section II will result in ineligibility for

the program. If I become ineligible, the stipend funds will be reversed (refunded) to the
STAR program. After the stipend is reversed, I will be responsible for paying all institutional
charges (tuition, fees, etc.) in relation to the Institutional Refund Policy, as stated in the
University Catalog.

Last Updated: 05/06/20 Page 2 of 4

SECTION III – TEACHING COMMITMENT

I must:
1. Successfully complete one year of residency at a high-need partner school.
2. Teach on a full-time basis for a minimum of four (4) years, not including the residency year,
in an approved LAUSD, high-need partner school, as defined by 20 US 6682 (3).
3. Begin the first school year of eligible full-time teaching service in an approved, high-need
partner school from the date I qualify for a preliminary teaching credential and secure a
teaching position.
4. Perform consecutive teaching years once I begin my teaching service until my obligation is
fulfilled.
5. Must adhere to the Professional Standards as stated in the CSI3 Credential Program
Expectations (signed by participant).
6. Provide any required employment verification establishing compliance with the above
requirements.
7. Agree that failure to comply with any item (1, 2, 3, 4, 5 OR 6) of Section III will result in a
requirement to repay the Stipend funds received.

SECTION IV –PROGRAM WITHDRAWAL

If I am unable to meet the course requirements or teaching commitment or choose to withdraw from
the program due to personal reasons, I will:

1. Immediately notify the STAR Program Coordinator in writing of my decision to withdraw.
2. Schedule an exit conference with the STAR Program Coordinator and the Director of STEM

Education and Teacher Development or Director of Operations within twenty-one (21) days
of notifying the STAR Program Coordinator of my decision to withdraw from the Program.
3. Receive repayment letter from program coordinator with further instructions following the
exit conference with the STAR Program Coordinator and the Director of STEM Education and
Teacher Development or Director of Operations.

SECTION V –REPAYMENT OBLIGATION

If I fail to meet the course requirements, to complete my teaching commitment, and/or withdraw
from the program, I shall:

1. Repay the amount of the Stipend award received to CSUDH Foundation.
2. Set up a repayment schedule if I am unable to repay the entire amount within 30 days of

withdrawal date.
3. Make payments to the STAR program according to the schedule established by the

program, which requires complete repayment within three (3) months after I enter
repayment status.
4. Agree that if I fail to repay the Stipend as stated in this Agreement, I will have to pay
reasonable collection costs, including but not limited to attorney’s fees, court costs and other
fees.

Last Updated: 05/06/20 Page 3 of 4

SECTION VI – ADDITIONAL REQUIREMENTS

I must:
1. Respond to all communications and requests from the STAR program and the University
Foundation within the time indicated.
2. Provide written notification to the STAR program and the University Foundation within
twenty-one (21) days of any change in my legal name or address or of any change in the
status affecting my eligibility.
3. Comply with any procedures deemed necessary and appropriate by the STAR program
and the University Foundation, all conditions cited in this Agreement, and all applicable rules
and regulations.

SECTION VII – APPEALS

Once I have been accepted to participate in the program, I may appeal any determination of non-
compliance within any provisions of the program in the following manner:

1. Provide a written notice of appeal, which includes a concise statement of the action being
challenged.

2. The notice of appeal must be postmarked within twenty (20) calendar days from the date
of the STAR program’s letter stating the decision being challenged.

3. Direct appeals shall be sent to the following individuals, in the following order:
(a) The Program Coordinator
(b) The CSI3 Executive Director

SECTION VIII – TAXES

This Grant may have tax consequences. Please consult with your tax professional.

SECTION IX – LEGISLATIVE ACTION

If the statutory authority for the STEM Teachers in Advanced Residency, STAR Program, including
authority for funding, is repealed, amended, or significantly modified, either by legislative action or
the administrative action of the federal agency that administers the STEM Teachers in Advanced
Residency Program, the University Foundation may modify this Agreement accordingly. In such
event, the STAR program will provide written notification of such changes.

I authorize the release of information pertinent to my Stipend by the STAR program and the
University Foundation or their agents, the U.S. Department of Education or any other party involved
in the administration of my Stipend or the terms identified in this Agreement. By my signature, I
acknowledge that I have read and understand the above information and that I am required to
fulfill my teaching obligation according to the terms and conditions herein.

Name (Printed) _______________________________ Phone Number ____________________

Signature ________________________________________ Date: ______________________

Permanent Address______________________________________________________________

Original kept with the CSI3 Office.

Last Updated: 05/06/20 Page 4 of 4

MATH & SCIENCE TEACHER INITIATIVE, MSTI
TRANSITION TO TEACHING, TTT

AGREEMENT TO SERVE

Center for Innovation in STEM Education, CISE
California STEM Institute for Innovation & Improvement, CSI3
Math & Science Teacher Initiative, MSTI – Transition to Teaching, TTT

1000 East Victoria Street | Carson, CA 90747
Phone (310) 243.2634

Last Updated: 05/06/20 Page 1 of 5

California State University Dominguez Hills (CSUDH)
Math and Science Teacher Initiative Program, MSTI

Transition to Teaching, TTT

The CSU Chancellor’s Office makes it possible for CSUDH to provide a MSTI-TTT stipend of up to
$1,500 for eligible individuals who commit to the program’s requirements leading to a:
- Multiple Subject Preliminary Credential with an Introductory Subject Matter Authorization

(ISMA) in Mathematics or Science OR
- Single Subject Preliminary Credential in Mathematics or Science OR
- Multiple Subject Preliminary Credential and Single Subject Preliminary credential in

Mathematics or Science

Letter of Agreement to Serve and Promissory Note

I, the undersigned “Recipient” for value received, understand and agree that unless I
fulfill the terms and conditions of this Letter of Agreement to Serve and Promissory Note, which I have
entered into with the Math and Science Teacher Initiative Program (MSTI)- Transition to Teaching (TTT)
and the University, I am obligated to repay the principal sum (“Stipend”) of up to $1,500 together
with any and all charges that may become due as provided in this Letter of Agreement and
Promissory Note.

I understand that the distribution of the grant is as follows: Participants in the MSTI-TTT
program will receive up to $1,500 stipend if they meet the following conditions.

SECTION I – PRELIMINARY CREDENTIAL PREREQUISITE REQUIREMENTS

In order to be eligible for the MSTI-TTT stipend, I understand that I must:
1. Be a MSTI-TTT program participant enrolled full-time in the teacher credential program
2. Attend all MSTI-TTT program activities
3. Meet the basic skills requirement (through passing CBEST, SAT, or ACT scores)
4. Meet the subject matter requirement (i.e., pass the CSET exam or be eligible for the SMPP
waiver)

SECTION II – COURSE WORK REQUIREMENTS

I understand that to retain eligibility to participate in the University’s MSTI-TTT Program, I must:

1. Be continuously enrolled in the credential program at CSUDH as a full time student in the
MSTI-TTT program and maintain satisfactory academic progress in the program, including
but not limited to earning grades of no less than a “B” in all education course work. These
standards are described in the University catalog.

2. Complete coursework and training necessary to obtain a teaching credential.
3. Attend ALL required STEAM Lab School sessions [refer to “CSI3 Credential Program

Expectations” for more details].
4. Attend ALL required Teacher Support Institute Sessions [refer to “CSI3 Credential Program

Expectations” for more details].
5. Agree that failure to comply with items 1,2,3, or 4 of Section II will result in ineligibility for

the program. If I become ineligible, the stipend funds will be reversed (refunded) to the
MSTI-TTT program. After the stipend is reversed, I will be responsible for paying all

Last Updated: 05/06/20 Page 2 of 5

institutional charges (tuition, fees, etc.) in relation to the Institutional Refund Policy, as
stated in the University Catalog.

SECTION III – TEACHING COMMITMENT

By my signature below, I agree and commit to:

1. Fulfill the MSTI-TTT program’s prerequisite requirements leading to a:
a. Multiple Subject Preliminary Credential with an Introductory Subject Matter
Authorization (ISMA) in Mathematics or Science or a
b. Single Subject Preliminary Credential in Mathematics or Science
c. Multiple Subject Preliminary Credential and Single Subject Preliminary Credential in
Mathematics or Science

2. Teach on a full-time basis for a minimum of four (4) years in a “high-need” LAUSD school
or other schools as approved by the MSTI-TTT program, as defined by 20 U.S.C. § 6682
(3) within a year of becoming eligible to serve as a full time teacher in the State of
California.

3. Begin the first school year of eligible full-time teaching service in a high-need LAUSD
school or another school as approved by the MSTI-TTT program from the date I qualify
for a preliminary multiple subject or single subject credential and secure a teaching
position.

4. Perform consecutive teaching years once I begin my teaching service until my obligation is
fulfilled.

5. Must adhere to the Professional Standards as stated in the Program Student Expectations
(signed by participant).

6. Provide any required employment verification establishing compliance with the above
requirements.

7. Agree that failure to comply with any item (1, 2, 3, 4, 5 OR 6) of Section III will result in a
requirement to repay the Stipend funds received.

SECTION IV – PROGRAM WITHDRAWAL

If I am unable to meet the MSTI-TTT prerequisite requirements or teaching commitment or choose
to withdraw from the program due to personal reasons, I agree to:

1. Immediately notify the Program Coordinator in writing of my decision to withdraw.
2. Schedule an exit conference with the Program Director or Program Coordinator within

twenty-one (21) days of notifying the Program Coordinator of my decision to withdraw
from the Program.
3. Receive repayment letter from program coordinator with further instructions following the
exit conference with the Program Director or Program Coordinator.

Last Updated: 05/06/20 Page 3 of 5

SECTION V – REPAYMENT OBLIGATION

If I fail to meet the MSTI-TTT prerequisite requirements or complete my teaching commitment,
and/or withdraw from the program, I shall:

1. Repay the amount of the Stipend award received to CSUDH within 30 days of my
withdrawal date or,

2. In the event that I am unable to repay the full amount within 30 days of withdrawal, I
agree to contact CSUDH within 30 days of my withdrawal in order to set up a repayment
schedule.

3. Make payments to the program according to the schedule established by the program,
which requires complete repayment within three (3) months after I enter repayment status.

4. Pay reasonable collection costs, including but not limited to attorney’s fees, court costs and
other fees, if I fail to repay the Stipend as stated in this Agreement.

SECTION VI – ADDITIONAL REQUIREMENTS

I agree to:
1. Respond to all communications and requests from the program and the University within
the time indicated.
2. Provide written notification to the program and the University within twenty-one (21) days
of any change in my legal name or address or of any change in the status affecting my
eligibility.
3. Comply with any procedures deemed necessary and appropriate by the program and the
University, all conditions cited in this Agreement, and all applicable rules and regulations.

SECTION VII – APPEALS

Once I have been accepted to participate in the program, I may appeal any determination of
non-compliance within any provisions of the program in the following manner:

1. Provide a written notice of appeal, which includes a concise statement of the action being
challenged.

2. The notice of appeal must be postmarked within twenty (20) calendar days from the date
of the program’s letter stating the decision being challenged.

3. Direct appeals shall be sent to the following individuals, in the following order:
(a) The Program Coordinator
(b) The Program Director

SECTION VIII – TAXES

I understand that this Grant may have tax consequences, and that it is recommended that I consult
with my tax professional.

Last Updated: 05/06/20 Page 4 of 5

SECTION IX – LEGISLATIVE ACTION
I understand that if the statutory authority for the Math & Science Teacher Initiative
Program/Transition to Teaching, including authority for funding, is repealed, amended, or
significantly modified by legislative action, the University may modify this Agreement accordingly.
In such event, the MSTI program will provide me written notification of such changes.
I authorize the release of information pertinent to my stipend by the MSTI-TTT program and the
University or their agents any other party involved in the administration of my stipend or the terms
identified in this agreement. By my signature, I acknowledge that I have read and understand
the above information and that I am required to fulfill my teaching obligation according to
the terms and conditions herein.

Name (Printed) _______________________________ Phone Number ____________________

Signature ________________________________________ Date: ______________________

Permanent Address______________________________________________________________

Original kept with the CSI3 Office.

Last Updated: 05/06/20 Page 5 of 5

Spring Intersession 2020 2019-2020
Academic Calendar
DATE DAY
DESCRIPTION
December 2-February 13 Monday-Thursday
December 2-May 20 Monday-Wednesday Spring Intersession 2020 Registration (Pell Grant eligible students)
Spring Intersession 2020 Registration (Students Not Using Pell
May 21-June 27 Thursday-Saturday Grant)
Spring 2020 Intersession
Summer Session 2020
Summer 2020 Registration, Session I and II (fees due at time of
March 16-July 5 Monday-Sunday registration)
Summer Session I
May 26-July 2 Tuesday-Thursday Late Registration, Add/Drop, Session I (fees due at time of
May 26-May 30 Tuesday-Saturday registration)
Fall 2020 Graduation Application Deadline
July 1 Wednesday Independence Day Holiday Observed (No Classes, Campus Closed)
July 3 Friday Independence Day Holiday (No Classes, Campus Closed)
July 4 Saturday Late Registration, Add/Drop, Session II (fees due at time of
July 6-July 11 Monday-Saturday registration)
Summer Session II
July 6-August 14 Monday-Friday

2019-2020 Academic Calendar Page 3 of 3

2020-2021 Academic Calendar

This is a DRAFT tentative calendar only. Chancellor’s Office Approval required.

Dates are subject to change.

Updated: 1/14/2020

Fall Semester 2020 DAY DESCRIPTION

DATE Monday Fall 2020 Registration begins via MyCSUDH
Monday-Sunday Registration via MyCSUDH - fees due Monday, June 1, 2020
April 20 Various Days New Student Orientation
April 20-May 31 Monday Memorial Day Holiday (No Classes, Campus Closed)
May-August Monday First day to file for Spring 2021 Graduation
May 25 Monday-Tuesday Registration via MyCSUDH - fees due 48 hours after registration
June 1 Wednesday Fall 2020 Graduation Application Deadline (without late fee)
June 1-September 8 Friday Independence Day Holiday Observed (No Classes, Campus Closed)
July 1 Saturday Independence Day Holiday (No Classes, Campus Closed)
July 3 Monday Academic Year Fall Semester Begins
July 4 Monday Academic Affairs Faculty Day
August 17 Friday Instructional Preparation Day
August 17 Sunday Last day for students on Waitlist to be added to classes; all waitlists
August 21 will be cancelled at midnight.
August 23 Classes Begin
Late Registration and Add/Drop via MyCSUDH - fees due 48 hours
August 24 Monday after registration
August 24-September 11 Monday-Friday Instructor Drop Deadline
Labor Day Holiday (No Classes, Campus Closed)
September 4 Friday Last Day to Drop from FT to PT Status with Refund
September 7 Monday Late Registration Add/Drop in person – fees due at time of
September 11 Friday registration
September 14-18 Monday-Friday Fall 2020 Graduation Application Deadline (with late fee)
Fall Convocation
September 15 Tuesday Credit/No Credit and Audit Grading Deadline
September 15 Tuesday Drop Without Record of Enrollment Deadline
September 21 Monday Student Census
September 21 Monday Serious and Compelling Reason Required to Withdraw
September 21 Monday The Great California ShakeOut at 10:15 am
September 22-November 6 Tuesday-Friday Winter 2021 Registration - fees due at time of registration
October 15 Thursday Spring 2021 Registration via MyCSUDH
October 17-December 16 Saturday-Wednesday Last Day for Pro-rata Refund of Non-Resident Tuition and Tuition
October 19-February 12 Monday-Friday Fees
October 23 Friday First day to file for Summer 2021 Graduation
Serious Accident/Illness Required to Withdraw
November 1 Sunday Veterans Day Holiday (No Classes, Campus Closed)
November 9-December 4 Monday-Friday Thanksgiving Day Holiday (No Classes, Campus Closed)
November 11 Wednesday Thanksgiving Break (No Classes, Campus Closed - Not a Holiday)
November 26 Thursday Spring Intersession 2021 Registration (Pell Grant eligible students)
November 27-29 Friday-Sunday Spring Intersession 2021 Registration (Students Not Using Pell Grant)
November 30-February 21 Monday-Sunday Last Day of Scheduled Classes
November 30-May 25 Monday-Tuesday Grade Submission Begins
December 4 Friday Final Examinations
December 5 Saturday Evaluation Day
December 5-11 Saturday-Friday Spring 2021 Graduation Application Deadline (with late fee)
December 14 Monday
December 16 Wednesday

Page 1 of 3

DRAFT – 2020/2021 ACADEMIC CALENDAR

2020-2021 Academic Calendar

This is a DRAFT tentative calendar only. Chancellor’s Office Approval required.

Dates are subject to change.

Updated: 1/14/2020

DATE DAY DESCRIPTION

December 16, 3 pm Wednesday Final Grades Due (Extended Education grades always due 72 hours
after course end date)
December 16 Wednesday Semester Ends
December 25-January 1 Friday-Friday Winter Break & New Year’s Day Holiday (No Classes, Campus Closed)

Winter Session 2021 Winter 2021 Registration - fees due at time of registration
Winter Session 2021
October 17-December 16 Saturday-Wednesday
New Year’s Day Holiday (No Classes, Campus Closed)
December 17-January 16 Thursday-Saturday
Spring 2021 Registration begins via MyCSUDH
January 1 Friday Registration via MyCSUDH - fees due Friday, November 6, 2020)
Registration via MyCSUDH - fees due 48 hours after registration
Spring Semester 2021 New Student Orientation
First day to file for Fall 2021 graduation
October 19 Monday Martin Luther King Jr. Holiday (No Classes, Campus Closed)
Spring Semester Begins
October 19-November 5 Monday-Thursday Instructional Preparation Day
November 6-February 12 Friday-Friday Last day for students on Waitlist to be added to classes; all waitlists
will be cancelled at midnight.
To Be Announced Classes Begin
Late Registration and Add/Drop via MyCSUDH - fees due 48 hours
January 1 Friday after registration
Summer 2021 Graduation Application Deadline (without late fee)
January 18 Monday Instructor Drop Deadline
January 19 Tuesday Last Day to Drop from FT to PT Status with Refund
President’s Day Holiday (No Classes, Campus Open)
January 22 Friday Late Registration and Add/Drop in person - fees due at time of
January 24 Sunday registration
Credit/No Credit and Audit Grading Deadline
January 25 Monday Drop without Record of Enrollment Deadline
January 25-February 12 Monday-Friday Student Census
Serious and Compelling Reason Required to Withdraw
February 1 Monday Summer 2021 Registration – fees due at time of registration
February 5 Friday Last Day for Pro-rata Refund of Non-Resident Tuition and Tuition
February 12 Friday Fees
February 15 Monday Spring Recess (includes César Chávez Holiday)
February 15-19 Monday-Friday César Chávez Day Holiday (No Classes, Campus Closed)
Summer 2021 Graduation Application Deadline (with late fee)
February 22 Monday Fall 2021 Registration begins via MyCSUDH
February 22 Monday Serious Accident/Illness Required to Withdraw
February 22 Monday Last Day of Scheduled Classes
February 23-April 16 Tuesday-Friday Grades Submission Begins
March 15-July 9 Monday-Friday Final Examinations
March 27 Saturday Commencement (for more information see ceremony schedule)
Evaluation Day
March 28-April 3 Sunday-Saturday
March 31 Wednesday
April 15 Thursday
April 19 Monday
April 19-May 14 Monday-Friday
May 14 Friday
May 15 Saturday
May 15-21 Saturday-Friday
May 21-22 Friday-Saturday
May 24 Monday

Page 2 of 3

DRAFT – 2020/2021 ACADEMIC CALENDAR

2020-2021 Academic Calendar

This is a DRAFT tentative calendar only. Chancellor’s Office Approval required.

Dates are subject to change.

Updated: 1/14/2020

DATE DAY DESCRIPTION

May 25, 3 pm Tuesday Final Grades Due (Extended Education grades always due 72 hours
after course end date)
May 25 Tuesday Semester/Academic Year Ends

Spring Intersession 2021 Spring Intersession 2021 Registration (Pell Grant eligible students)
Spring Intersession 2021 Registration (Students Not Using Pell Grant)
November 30-February 21 Monday-Sunday Spring 2021 Intersession
Memorial Day Holiday (No Classes, Campus Closed)
November 30-May 25 Monday-Tuesday
Summer 2021 Registration, Sessions I and II – fees due at time of
May 26-June 30 Wednesday-Wednesday registration
First day to file for Spring 2021 Graduation
May 31 Monday Late Registration and Add/Drop, Session I – fees dues at time of
registration
Summer Session 2021 Summer Session I
Fall 2021 Graduation Application Deadline (without late fee)
March 15-July 9 Monday-Friday Independence Day Holiday (No Classes, Campus Closed)
Independence Day Holiday Observed (No Classes, Campus Closed)
June 1 Tuesday Late Registration and Add/Drop, Session II – fees due at time of
June 1-7 Tuesday-Monday registration
Summer Session II
June 1-July 9 Tuesday-Friday
July 1 Thursday
July 4 Sunday
July 5 Monday
July 10-16 Saturday-Friday

July 10-August 13 Saturday-Friday

Page 3 of 3

DRAFT – 2020/2021 ACADEMIC CALENDAR

STIPEND CERTIFICATION AND PAYMENT REQUEST

Payee Information CSUDH STUDENT  Yes No

Date: ____________________________________________ If Yes, Student ID#
Name: ___________________________________________
Address: _________________________________________ Request Deadline  Check ready 
City, State, Zip Code: _______________________________         Before 12 pm Thursday  Tuesday at 4pm 
Social Security: ____________________________________ Before 12 pm Tuesday  Friday at 4pm 

FOUNDATION ACCOUNT#_______________________

Requirements (List requirements to receive payments) 

Payment Information Amount No. Disbursement Date Amount
No. Disbursement Date 7.
1. 8.
2. 9.
3. 10.
4. 11.
5. 12.
6.

Stipend Receipt Certification

I certify that I have met/will meet the necessary requirements to receive the stipend payments listed above. I also
understand that these payments may be considered taxable income by the IRS and that I am liable for any local, state, 
or  federal  taxes  due.  I  understand  it  is  my  responsibility  to  consult  a  qualified  tax  accountant  to  determine  the 
consequences of these payments.

Stipend Recipient Signature  Date

Account Director Certification

I certify that the stipend recipient listed above has met/will meet all the necessary requirements to receive payment

as indicated.

__________________________________________________             Date
Account Director Signature         

*For Philanthropic Account Amounts Over $750 Must Receive Dean or VP Approval.

___________________________________________________________ Date 
Dean/VP Approval (For Philanthropic Account Amounts over $750)
Date
______________________________________________________ 
Foundation Approval INDICATE ONE ONLY

PEID Mail to Address listed above
Account Balance Call when ready @ Ext. 

FDN#162 11/13

State of California Vendor #

VENDOR DATA RECORD C.S.U.D.H. Use Only

(Required in lieu of IRS W-9 when doing business with the State of California)

STD. 204 (REV. 2-97) (CSUDH Rev. 7/03)
NOTE: Governmental entities, federal, state, and local (including public school districts) are not required to submit this form

1 DEPARTMENT/OFFICE PURPOSE: Information contained in this form
will be used by state agencies to prepare
PLEASE CSU, Dominguez Hills - FOUNDATION information Returns (Form 1099) and for
RETURN TO: withholding on payments to non-resident
STREET ADDRESS 1000 E. Victoria St - WCH 360 vendors. Prompt return of this fully completed
2 form will prevent delays when processing
CITY, STATE, ZIP CODE Carson, CA 90747 payments.

TELEPHONE NUMBER Vendor PHONE NUMBER

(310) 243 - 3306

VENDOR’S BUSINESS NAME

SOLE PROPRIETOR - ENTER OWNER’S FULL NAME HERE (Last, First, M.I.)

MAILING ADDRESS (Number and Street or P.O. Box #)
(City, State and Zip Code)

3 MEDICAL CORPORATION (Including dentistry, ESTATE OR TRUST NOTE:
Podiatry, psychotherapy, optometry, chiropractic, etc.) LEGAL SERVICE - Government entities
VENDOR’S EXEMPT CORPORATION (Nonpro t) INDIVIDUAL/SOLE PROPRIETOR - CSUDH employees
ENTITY (Must provide Social Security #) - CSUDH students
TYPE ALL OTHER CORPORATIONS are not required to
submit this form.
PARTNERSHIP

4 SOCIAL SECURITY NUMBER REQUIRED FOR INDIVIDUAL/SOLE PROPRIETOR BY AUTHORITY OF REVENUE NOTE:
AND TAXATION CODE SECTION 18646 (See reverse) Payment will not be
VENDOR’S processed without an
TAXPAYER FEDERAL EMPLOYERS IDENTIFICATION (FEIN) SOCIAL SECURITY NUMBER / ITIN accompanying taxpayer
I.D. NUMBER I.D. number.
IF VENDOR ENTITY TYPE IS A IF VENDOR ENTITY TYPE IS INDIVIDUAL OR SOLE PROPRIETOR, NOTE:
CORPORATION, PARTNERSHIP, ESTATE ENTER SSN. ITN / SSN IF RESIDENT OF FOREIGN COUNTRY
Prior to making payments to
OR TRUST, ENTER FEIN. foreign citizens, United States tax
laws require all employers to
5 Check All Boxes That Apply To You perform a tax analysis with respect
to country of citizenship and other
VENDOR For Federal Income Tax Withholding: IRS rulings to determine a person’s
RESIDENCY residency for Federal tax purposes.
DECLARATION I Am a U.S. Citizen I am a Permanent Resident Alien and I Have a Green Card.

I Am Not a U.S. Citizen and I Do Not Have a Permanent Resident Green Card.
Note: Foreign National Citizens must complete a tax analysis before payments can be made.
I am Tax Exempt by Tax Treaty. My Country is:

All Payments Made For California State Tax Withholding: NOTE:
By The University I am a California Resident Quali ed to do business in CA or have a permanent place of business in CA.
Are Subject To An estate is a resident if decedent
Federal & State I am a California Nonresident (See Reverse). Payments to CA nonresidents may be subject to state taxes. was a California resident at time
Tax Laws A Waiver from CA state tax withholding is attached (From the California Franchise Tax Board). of death. A trust is resident if one
or more trustees are CA residents.
All services related to this payment were performed OUTSIDE of the state of California. Rules for accessing State taxes
di er signi cantly from Federal
tax rules.

6 I hereby certify under penalty of perjury under the laws of the State of California that the information provided on this document is
true and correct. If my residency status should change, I will promptly inform you.
CERTIFYING
SIGNATURE AUTHORIZED VENDOR REPRESENTATIVE’S NAME (PRINT) TITLE

SIGNATURE DATE PHONE NUMBER

State of California

VENDOR DATA RECORD

(STD. 204 (REV. 2-97) (REVERSE)

ARE YOU A RESIDENT OR NONRESIDENT? ARE YOU SUBJECT TO NONRESIDENT WITHHOLDING?
Each corporation, individual/sole proprietor, partnership, estate, or Payments made to nonresident vendors including
trust doing business with the State of California must indicate corporations, individuals partnerships, estates and trusts
residency status along with their vendor identi cation number. are subject to income tax withholding. Nonresident
A corporation if it has a permanent place of business in California. vendors performing services in California or receiving rent,
The corporation has a permanent place of business in California if it lease or royalty payments from property (real or personal)
is organized and existing under the laws of this state or, if a foreign located in California will have 7% of their total payments
corporation has quali ed to transact intrastate business. A corpora- withheld for state income taxes. However, no California
tion that has not quali ed to transact intrastate business (e.g., a tax withholding is required if total payments to the vendor
corporation engaged exclusively in interstate commerce) will be are $1,500 or less for the calendar year.
considered as having a permanent place of business in this state
only if it maintains a permanent o ce in this state that is perma- A nonresident vendor may request that income taxes be
nently sta ed by its employees. withheld at a lower rate or waived by sending a completed
For individual/sole proprietors, the term “resident” includes every form FTB 588 to the address below. A waiver will generally
individual who is in California for other than a temporary or transito- be granted when a vendor has a history of ling California
ry purpose and any individual domiciled in California who is absent returns and making timely estimated payments. If the
for a temporary or transitory purpose. Generally, an individual who vendor activity is carried on outside of California or
comes to California for a purpose which will extend over a long or partially outside of California, a waiver or reduced
inde nite period will be considered a nonresident. withholding rate may be granted. For more information,
For withholding purposes, a partnership is considered a resident contact:
partnership if it has a permanent place of business in California. An
estate is considered a California estate if the decedent was a Franchise Tax Board
California resident as the time of death and a trust is considered a Withhold at Source Unit
California trust if at least on trustee is a California resident. Attention: State Agency Withholding Coordinator
More information on residency status can be obtained by calling the P.O. Box 651
Franchise Tax Board at the numbers listed below: Sacramento, CA 95812-0651
From within the United States, call 1-800-852-5711 Telephone: (916) 845-4900
From outside the United States, call 1-916-845-6500 Fax: (916) 845-4831
For hearing impaired with TDD, call 1-800-822-6268
If a reduce rate of withholding or waiver has been authorized
by the Franchise Tax Board, attach a copy to this form.

PRIVACY STATEMENT
Section 7(b) of the Privacy Act of 1974 (Public Law 93-5791) requires that any federal, state, or local governmental agency which
requests an individual to disclose his social security account number shall inform that individual whether that disclosure is manda-
tory or voluntary, by which statutory or other authority such number is solicited, and what uses will be made of it.
The State of California requires that all parties entering into business transactions that may lead to payment(s) from the State must
provide their Taxpayer identi cation Number (TIN) as required by Revenue and Taxation Code Section 186746, to facilitate tax
Section 6109(a). The TIN for individuals and sole proprietorships is their Social Security Number (SSN).
It is a mandatory to furnish the information requested. Federal law requires that payments for which the requested information is
not provided be subject to a 31% withholding and state law imposes noncompliance penalties up to $20,000.
You have the right to access records containing your personal information, such as your SSN. To exercise that right, please contact
the business services unit or the accounts payable unit of the state agency(ies) with which you transact that business.
Please call the Department of Finance, Fiscal Systems and Consulting Unit at (916) 324-0385 if you have any questions regarding
this Privacy Statement. Questions related to residency or withholding should be referred to the telephonne numbers listed above.
All other questions should be referred to the requesting agency listed in section 1.

Foundation Use Only May 7, 2020 Foundation Employee ID # DIRECT DEPOSIT/DIRECTPAY
Date printed AUTHORIZATION

EMPLOYEE INFORMATION Vendor ID#

Last First M.I. Campus E-mail Address Phone #

Address

Street City State Zip

BANK ACCOUNT INFORMATION

Account Type: Bank Name:

Routing No. Account No.

TERMS AND CONDITIONS

I authorize the California State University, Dominguez Hills Foundation to initiate credit and/or debit entries into the account and financial
institution indicated above.

I understand and agree that this enrollment applies to all payroll and accounts payable transactions.

I understand and agree that the origination of any and all ACH transactions must comply with the applicable provisions of U.S. law.

I understand and agree that future disbursements made to me will be processed through electronic ACH once this form is received and processed. I
understand that this cannot be modified except through deactivation of my enrollment.

I understand that deposits will be made to the account and financial institution approximately two (2) business days after the processing date
described above, and that any delays in this process are outside of the control of the California State University, Dominguez Hills
Foundation.

I understand and agree that this authorization will remain in full force and effect until the California State University, Dominguez Hills Foundation
receives written notification from me of its termination (through the submission of this form with the "deactivate" selection) in such time and in
such manner as to afford the California State University, Dominguez Hills Foundation and the banking institution indicated above a reasonable
opportunity to act on it.

I understand and agree that this authorization and agreement shall apply to all payments made by any of the auxiliary entities administered by the
California State University Dominguez Hills Foundation, including the Associated Students, Inc., Loker Student Union and the Philanthropic
Foundation.

AUTHORIZATION FOR DIRECT PAY AND DIRECT DEPOSIT

Activate De-Activate

Name (Print)

Signature Date

Please submit to: CSUDH Foundation

1000 E. Victoria Street, Carson, CA 90747, SCC-2, Room 202

* Please attach supporting documents from bank, either in the form of a voided check or otherwise. Do not e-mail this form.

DIRECT DEPOSIT/DIRECTPAY
AUTHORIZATION

(Do not attach this page when submitting form)

WHERE TO FIND ROUTING AND ACCOUNT NUMBER

The image below shows how to locate your account number and routing number.

The line of numbers and special symbols at the bottom of one of your personal checks contains the information you
need to make your direct deposit election.
Routing/Transit Number Your routing/transit number is the nine digit number which appears furthest to the left at
the bottom of your personal check.
Account Number Your account number usually appears to the right of the routing-transit number. It can be up to 17
positions in length and contains only digits and possibly hyphens. If the account number printed on your check
contains spaces, you don't need to enter the spaces.

Note: Some banks display the check number to the left of the account number. Be sure you don't include the
check number as part of the account number.

LOS ANGELES UNIFIED SCHOOL DISTRICT
SINGLE-TRACK INSTRUCTIONAL SCHOOL CALENDAR 2020-2021

JULY FR AUGUST FR SEPTEMBER FR
3 7 4
MO TU WE TH 10 MO TU WE TH 14 MO TU WE TH 11
12 17 3456 21 123 18
24 10 11 12 13 28 25
6789 31 17 18 19 20 7 8 9 10
13 14 15 16 24 25 26 27 14 15 16 17
20 21 22 23 31 21 22 23 24
27 28 29 30 28 29 30

OCTOBER FR NOVEMBER FR DECEMBER FR
2 6 4
MO TU WE TH 9 MO TU WE TH 13 MO TU WE TH 11
1 16 2345 20 123 18
23 9 10 11 12 27 25
5678 30 16 17 18 19 7 8 9 10
12 13 14 15 23 24 25 26 14 15 16 17
19 20 21 22 30 21 22 23 24
26 27 28 29 28 29 30 31

JANUARY FR FEBRUARY MARCH FR
MO TU WE TH 1 MO TU WE TH FR 5
8 MO TU WE TH 12
4567 15 12345 1234 19
11 12 13 14 22 8 9 10 11 12 8 9 10 11 26
18 19 20 21 29 15 16 17 18 19 15 16 17 18
25 26 27 28 22 23 24 25 26 22 23 24 25
29 30 31

APRIL FR MAY FR JUNE
2 7
MO TU WE TH 9 MO TU WE TH 14 MO TU WE TH FR
1 16 3456 21 1234
23 10 11 12 13 28
5678 30 17 18 19 20 7 8 9 10 11
12 13 14 15 24 25 26 27 14 15 16 17 18
19 20 21 22 31 21 22 23 24 25
26 27 28 29 28 29 30

07/03/20 . . . . . . . . . . . . I.n.d.e.p.e.n.d. e. nce Day Observed 01/11/21 . . . . . . . . . . . . S.e.c.o.n. d. .S.e.mester Begins

08/18/20 . . . . . . . . . . . . F.i.rs.t. D. .ay of Instruction 01/18/21 . . . . . . . . . . . . D. .r.. M. .a.rtin L. King Birthday

09/04/20 . . . . . . . . . . . . A. d. .m.i.ssion Day 02/15/21 . . . . . . . . . . . . P. r.e.sidents' Day

09/07/20 . . . . . . . . . . . . L.a.b.o. r. Day 03/26/21 . . . . . . . . . . . . C. esar E. Chavez Birthday Observed

11/11/20 . . . . . . . . . . . . V. e. t.e.r.a.n.s. Day 03/29 - 04/02/21 . . . . . .S.p.ring Recess

11/26 - 11/27/20 . . . . . .T.h.anksgiving Holiday 05/31/21 . . . . . . . . . . . . M. .e.morial Day

12/21/20 - 01/08/21 . . .W. .in.t.e.r Recess 06/10/21 . . . . . . . . . . . . L.a.s.t.Day of Instruction

LEGEND:

First Day/Last Day of Instruction Instructional Days
Legal/Local Holidays Fall Semester. . . . . . . . . . . . . . 80
School Recess Spring Semester. . . . . . . . . . . 100
Unassigned Day (schools not in session) Total. . . . . . . . . . . . . . . . . . . . . . 180
Pupil Free Days *
Second Semester Begins

* Scheduled pupil free days are Monday, August 17, 2020 and Friday, June 11, 2021.
If a school selects Monday, January 11, 2021 as a pupil free day, then Friday, June 11, 2021 becomes an instructional day.

Board Approved
December 12, 2017

IMPORTANT RESOURCES
CSUDH Website
College of Education Website
CSI3 Website
2020-2021 University Catalog
College of Education, Teacher Education Division Handbook
Office of Financial Aid
2020-2021 Financial Aid Guide
Summer 2020 Financial Aid Form
Student Health and Psychological Services
Food and Shelter Resources
Student disAbility Resource Center
Career Center
OUR PARTNERS
Los Angeles Unified School District
Green Dot Public Schools: Careers

California State University
Dominguez Hills

California STEM Institute for Innovation and Improvement, CSI3
College of Education  Division of Teacher Education
Phone (310) 243-2634  Fax (310) 516-4280

Authorization for Use or Disclosure of Contact Information

I, __________________________________, 
authorize CA STEM Institute for Innovation and
Improvement, CSI3, 
to
use
 and
disclose
my contact
information
to their partnership
representatives for the sole purpose of recruitment and job placement as they deem necessary. And
for collaboration purposes, my information may also be shared with other CSI3 candidates and
instructors.

______ I
understand
that
I
have
the
right
to
revoke
this
authorization, in
writing, at
any
time.

I
understand
that
a
revocation
is
not
effective
to
the
extent
that
any
 person
or
entity
has

already
acted
in
reliance
on
my
authorization.

______ I
understand
that
my
interview or continued processing will not
be
conditioned
on

whether
I
sign
this
authorization.

This
authorization
for
release
of
information shall
be
in
effect
beginning at the time that this
release form is signed and submitted to CA STEM Institute for Innovation and Improvement, CSI3.

____________________________________
Signature of Candidate

____________________________________
Printed name of Candidate

____________________________________
Date

Audio/Video/Visual Image/Interview Release Form

I grant permission to the Board of Trustees of the California State University on behalf of California State
University, Dominguez Hills (CSUDH), and its officers, directors, auxiliary organizations, employees, and agents
(collectively “CSUDH”), to take and use audio, video, or visual image content of me; and/or interview me and use
my quotes and information I provide; and/or use any audio/video/visual image/concept ideas produced by me,
which I represent that I took or otherwise created and which are not an impermissible or otherwise unlawful
copy, duplication, or reproduction of another person’s work. Content includes, but is not limited to, text,
software, scripts, graphics, photos, digital images, drawings, renderings, voices, sounds, music, videos, audio
recordings, audiovisual combinations, and any associated or accompanying written communications or
descriptions.

I agree that CSUDH owns the audio/video/visual image/interview Content collected as part of the event listed
below, and all rights related to such Content. I further agree that without notifying me, CSUDH, its employees,
and agents may use the audio/video/visual image/interview Content at its sole discretion in any print, electronic,
or other media or format, including, but not limited to, university-approved websites, print or digital
publications, presentations, educational courses, videos, film, promotions, broadcasts, advertisements, posters,
video signage, radio, social media, as well as for certain approved non-university uses.

I waive any right to inspect or approve the finished images or any printed or electronic matter that may be used
with them. I further acknowledge that I voluntarily agree to participate in and/or provide audio/video/visual
image/interview Content to the CSUDH without the promise of compensation or remuneration in any form
whatsoever, and I waive any claim for compensation or remuneration of any kind for CSUDH’s use or publication
for the audio/video/visual image/interview Content.

I release CSUDH and any firm authorized to publish, broadcast, and/or distribute a finished product containing
the audio/video/visual image/interview Content, from any claims, damages, or liability, including attorneys’ fees,
that I may ever have in connection with the taking or use of the audio/video/visual image/interview Content or
material used with the audio/video/visual image/interview Content, including, but not limited to, any and all
claims for copyright infringement, invasion of privacy, defamation, false light, or misappropriation of name,
likeness, or image.

IF RELEASOR IS 18 YEARS OF AGE OR OVER:
I am at least 18 years of age and competent to sign this release. I have read this release before signing, I
understand its contents, meaning and impact, and I freely accept the terms.

______________________________________________ ________________________________
Name (please print) Date

______________________________________________ ________________________________
Signature Telephone

______________________________________________ __________________________________________
E-mail address User Name: Twitter/Instagram/Facebook (circle)

March 2018

IF RELEASOR IS UNDER 18 YEARS OF AGE:
I am the parent or legal guardian of the minor Releasor. I have read this release before signing; I understand the
legal consequences of its contents, meaning, and impact; and I freely accept the terms on behalf of the minor
Releasor and agree to be bound by the terms of this document.

I have read this document, and I am signing it freely. No other representations concerning the legal effect of this
document have bene made to me.

_______________________________________________
Minor Releasor’s Name (please print)

_______________________________________________ ________________________________
Name of Minor Releasor’s Parent/Guardian (please print) Date

_______________________________________________ ________________________________

Signature of Minor Releasor’s Parent/Guardian Telephone

______________________________________________
E-mail address

Project Name
(Photographer Name/Contact Information/Location/Notes/Photo Caption)

*KEEP ON FILE IN YOUR DEPARTMENT*

_______________________________________________
Department Name

_______________________________________________ ________________________________

Name Title

March 2018