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APPLICATION FOR RECERTIFICATIONAUTOMOBILE
NOTE: A separate Application for Recertification must be completed for each programrequesting certification e.g., general automobile, Ford ASSET, GM ASEP, Toyota T-TEN etc.
INSTITUTION:
Skyline CollegeNameAutomotive TechnologyProgram3300 College DriveStreetSan BrunoCity(650)738-4100
CA 94066State Zip
http://www.skylinecollege.edu/automotive/Telephone Program Website
ADMINISTRATOR OF THE INSTITUTION:
Victoria P, Morrow, Ph.D. President, Skyline CollegeName Title
(650) 738-4111 [email protected] E-mail
PERSON RESPONSIBLE FOR COORDINATION OF SELF-EVALUATION:
Tom Broxholm Automotive InstructorName Title
(650)738-4131 [email protected] _Telephone E-mail
LEVEL OF PROGRAM BEING EVALUATED:I I Secondary [X] Post-Secondary | | Secondary & Post-Secondary
10/09
Please indicate which of the following three options your program will certify under:
^Stand-Alone Program - Programs must be able to meet the minimum requirements for atleast the four required areas of Brakes, Electrical/Electronic Systems, Engine Performance, andSuspension & Steering.
-OR- Programs that are unable to meet the minimum requirements for stand-alone programcertification may consider the following options for articulated certification:
[U Traditional Articulation - This option allows schools to certify in Electrical/ElectronicSystems (required) and at least one other required automobile specialty area, and articulate withanother ASE certified program that provides instruction in at least the other two required areas.
Q]General Service Technician Program - This option is intended to serve automobileprograms in areas where the local employers prefer to hire graduates who have a broad skill setand general understanding of all automotive systems rather than skill sets with greater depth infewer areas; an articulation agreement with an ASE certified program is required. For moreinformation please refer to the General Service Technician Program Standards section of themanual. Note: E-leaning instructional hours that take place outside of the regularly scheduledclassroom and lab/shop timeframe cannot be used for the purpose of meeting GSTinstructional hour requirements at this time.
PROGRAM HOURS
Record the number of hours of instruction in the laboratory or shop and in the classroom for theareas in which program certification is being requested. Note: The 'E-Learning' column isdesignated for program hours that take place outside of the regularly scheduled classroom andlab/shot) timeframe. If you are not applying for certification under Standard 11 (E-Learning)do not enter program hours in the E-Learnins column.
AREA
BrakesElectrical/Electronic
Systems
Engine Performance
Suspension & SteeringAutomatic Transmission
& Transaxle
Engine Repair
LAB/SHOP +CO-OP
90
180
360
90
80
180
CLASSROOM+
90
180
360
90
80
180
E-LEARNING+ = PROGRAMTOTAL
180
360
720
180
160
360
10/09
Heating & Air Conditioning
Manual Drive Train & Axles
LPG Diagnosis and Repair
LPG Maintenance
LPG Conversion/Installation
CNG Diagnosis and Repair
CNG MaintenanceCNG
Conversion/Installation
General Service Technician
72
100
N/A
72
100
N/A N/A
144
200
0
0
0
0
0
0
**IT IS UNDERSTOOD THAT ALL EXPENDITURES INCURRED FOR THE ON-SITE EVALUATION WILL BE PAID BY THE AUTOMOBILE PROGRAM ORINSTITUTION REQUESTING CERTIFICATION. **
Institution Administrator - Signature
Victoria P. Morrow, Ph.D., President, Skyline CollegeInstitution Administrator - Name and Title (print or type)
f .A *
£>ate<
Program Instructor - Signature
Tom Broxholm, Automotive Instructor
Date
Program Instructor - Name and Title (print or type)
10/09
Print or type the names of the Advisory Committee members who conducted the automobileprogram review and self-evaluation (minimum of 4).
1. Dave Campbell
2. Kris Cesena
4. Zim Gwee
5.
3. Dan D'Amico
I PARTICIPATED IN THE RECERTIFICATION SELF-EVALUATION AND APPROVEDTHE RECERTICATION SUMMARY REPORT AS EVIDENCED BY MY SIGNATUREBELOW.
Dave Campbell £&/&//£>Printed or Typed Name
Kris Cesena
Date
3.
4.
5.
6.
Printed or Typed Name
Dan D'Amico IO/6// /0Signature Printed or Typed Name
Zim Gwee
Date
Printed or Typed Name Date
Signature Printed or Typed Name Date
Signature Printed or Typed Name Date
Note: Programs submitting their application electronically, must agree to the followingstatement:
By submitting this application electronically, I certify that the information I have provided onthis application is true and correct. By checking the "Yes" box below, I am "signing" theapplication. Furthermore, by typing in names where signatures are required, I agree that acomplete paper copy of the application with signatures (Institution Administrator, ProgramInstructor, and Advisory Committee Members) is available upon request.
^ Yes, I agree to the above statement
[~| N/A (submitting signed application through mail)
10/09
RECERTIFICATION SUMMARY SHEET
STANDARD RATING
STANDARD 1 - PURPOSE
The automobile technician training program shouldhave clearly stated program goals, related to the needsof the students and employers served. 5^
STANDARD 2 - ADMINISTRATION
Program administration should ensure that instructionalactivities support and promote the goals of the program.
STANDARD 4 - FINANCES
Funding should be provided to meet the program goalsand performance objectives.
STANDARD 5 - STUDENT SERVICES
Systematic skills assessment, interviews,counseling services, placement and follow-up proceduresshould be used.
Does the Advisory Committee convene a minimum of twoworking meetings per year with at least five in attendance(excluding school personnel)? [X] Yes | ] NO
STANDARD 3 - LEARNING RESOURCES
Support materials, consistent with both program goalsand performance objectives, should be available to staffand students. 5
Does the Advisory Committee review the information froman annual follow-up procedure and provide input for modificationsto the program? [X] Yes I I No
10/09
RATINGSTANDARD
STANDARD 6 - INSTRUCTION
Instruction must be systematic and reflect programgoals. A task list and specific performance objectiveswith criterion referenced measures must be used.
Automobile Area
BrakesElectrical/Electronic SystemsEngine PerformanceSuspension & SteeringAutomatic Transmission & TransaxleEngine RepairHeating & Air ConditioningManual Drive Train & Axle
.:-'\i::iJiii:-CN<l; ; ' . . ; W:iiiiSJI
General Service Technician
* The following question applies to General Service Technician Programs only:
*Does the GST program provide theory and "hands-on" training for 100% of the tasks?
DYES DNO
#ofHours
180360720180160360144200
P-l10010010010095969595
P-2959610098909690100
P-365961007075857080
*see below *see below *see below
Are the tools and equipment available for the tasks taught in each program area?*
Automobile Area Area Rating
BrakesElectrical/Electronic SystemsEngine PerformanceSuspension & SteeringAutomatic Transmission & TransaxleEngine RepairHeating & Air ConditioningManual Drive Train & Axles
-YesYesYes DNoYesYesYesYes
l Yes DNo
10/09
Automobile AreaArea Rating
^ il : il;::v : • ;y s£
General Service Technician
10/09
STANDARD 7 - EQUIPMENT
Equipment and tools used in the automobile technician training programmust be of the type and quality found in the repair industry and mustalso be the type needed to provide training to meet the program goalsand performance objectives. 5
Are all shields, guards, and other safety devices in place, operable, and used? [X]Yes
Do all students, instructors, and visitors wear safety glasses in the lab/shoparea while lab is in session? [X]Yes I iNo
STANDARD 8 - FACILITIES
The physical facilities must be adequate to permitachievement of the program goals and performance objectives.
STANDARD 9 - INSTRUCTIONAL STAFF
The instructional staff must have technical competencyand meet all state and local requirements for certification.
Do all instructors hold current ASE certification in the area(s)they teach? (N/A for General Service Technician ProgramInstructors) ' [X]Yes QNo
Do all instructors attend a minimum of 20 hours per year of recognizedindustry update training relevant to the areas in which the program iscertified? [X]Yes
The following question applies to General Service Technician Programs only:
Do GST instructors hold current ASE certification in:
1. A4 QYes QNo2. A5 D Yes Q No3. A6 D Yes Q No4. A8 D Yes Q No
STANDARD 10 - COOPERATIVE AGREEMENTS
Written policies and procedures should be used for cooperative andapprenticeship training programs (N/A if program does not offercooperative/apprenticeship programs). NA
10/09
STANDARD 11 - E-LEARNING
Written policies and procedures must be followed when e-learning curricularmaterials are used outside of scheduled classroom/lab/shop time for the purposeof meeting NATEF instruction hour requirements. (For programs using e-learningfor the purpose of meeting NATEF instructional hour requirements,support for a 'YES* response must be provided for each criterion below.)
Is there documentation that students have access to appropriate technologyfor e-learning purposes? [X] YES [UNO Q N/A
Are the content/tasks that are to be delivered via e-learning clearlyhighlighted in the course of study? [x] YES D NO D N/A
Is there documentation that e-learning is incorporated into the content/tasksin the program plan? [X] YES O NO G N/A
Do the instruction hours to be credited toward meeting up to 25 percent ofthe program specialty hour requirements correlate with the vendor'saverage completion time for each instruction module? [X] YES I I NO Q N/A
Is there documentation of the implementation and use of e-learninginstructional materials as evidenced in a Learning Management System(LMS)? " [X]YES DNO DN/A
Are Advisory Committee meeting minutes available to confirm that thecommittee has discussed and approved e-learning? [><] YES O NO n N/A
Standard 11Number of'Yes' responses 6
(as many as 6 items)
10/09
ON-SITE EVALUATION TEAM MEMBER LIST
Automobile RecertificationNOTE: There must be one evaluation team member from a dealership, one evaluation team member froman independent repair facility, and one alternate team member (dealership or independent repair facility)identified for a recertification on-site evaluation. See the "Information About On-site Evaluation Teams"section for selection criteria.
*For certification in CNG/LPG areas, one of the team members must be an experienced CNG/LPGtechnician (see Light/Medium Duty CNG/LPG certification materials for details).
* Team members must not be Advisory Committee members, former students, orinstructors of the program within the past ten years,
1. TEAM MEMBER FROM DEALERSHIP:
Minh Lam _ ___Name
TechnicianPosition (Title)
City Toyota __ __Company Name72 Bismark, Daly City, CA 94014Company Address
Years of hands-on experience: Total automobile! 8 LPG I I CNG f~l
High school graduate or equivalent; [XJYES I |NO
ASE Automobile Certifications (recommended):Master Technician
2. TEAM MEMBER FROM INDEPENDENT REPAIR FACILITY:
Sammy Soo HOPName
Technician „_____Position (Title)
Topline Automobile, Inc.Company Name1028 Carolan Avenue, Burlingame, CA 94010Company Address
Years of hands-on experience: Total automobile 16 LPG [~| CNG Fl
High school graduate or equivalent: [X]YES I [NO
ASE Automobile Certifications (recommended):A-2-, A-3, A-4, A-5, A-6, A-8, and L-l
3. TEAM MEMBER FROM DEALERSHIP, INDEPENDENT REPAIR FACILITY, OR10 10/09
AUTOMOBILE TRAINING PROGRAM:
Peter DabaiNameTechnicianPosition (Title)R & M AutomotiveCompany Name824 Ellis Street, San Francisco, CA 94109Company Address
Years of hands-on experience: Total automobile 15 LPG I I CNG I I
High school graduate or equivalent: [XJYES I |NO
ASE Automobile Certifications (recommended):A6,A8, LI
i l 10/09
AUTOMOBILE INSTRUCTOR QUALIFICATION SHEET
Instructor Tom Broxholm(please print or type)
Current ASE Certifications:
A-l Engine Repair
A-2 Automatic Transmission/Transaxle
A-3 Manual Drive Train & Axles
A-4 Suspension & Steering
A-5 Brakes
A-6 Electrical/Electronic Systems
A-7 Heating & Air Conditioning
A-8 Engine Performance
ASE H># (required) IW5ITOTLOBROXH(as it appears on your certificate)
Valid Until
12/2015
12/2015
12/2015
12/2015
12/2015
12/2015
12/2015
12/2015
F-l Light VecMele.--*CompressedNatoraiGas - .vy*.1.- . . . . : • ; ' • • ' • Vwvu-^Indicates instructor certifications required for General Service Technician Program
Please indicate the areas taught by this instructor:
Brakes Q
Electrical/Electronic System d]
Engine Performance [~1
Suspension & Steering I I
Automatic Transmission/Transaxle [X]
Engine Repair I I
Heating and Air Conditioning [""]
Manual Drive Train £ Axles [X]
LPG Diagnosis and Repair Q
LPG Maintenance I I
LPG Conversion/Installation [~~]
CNG Diagnosis and Repair I I
CNG Maintenance Q
CNG Conversion/Installation Q
General Service Technician Program*
10/09
AUTOMOBILE INSTRUCTOR QUALIFICATION SHEET
Instructor Richard L. Escalambre(please print or type)
Current ASE Certifications:
ASE ID# (required) QU9GP9PJ8ESCAL(as it appears on your certificate)
Valid Until
A-l Engine Repair
A-2 Automatic Transmission/Transaxle
A-3 Manual Drive Train & Axles
A-4 Suspension & Steering
A-5 Brakes
A-6 Electrical/Electronic Systems
A-7 Heating & Air Conditioning
A-8 Engine Performance
Frl Oj&t^
06/2012
06/2012
06/2013
06/2013
06/2012
^Indicates instructor certifications required for General Service Technician Program
Please indicate the areas taught by this instructor:
Brakes HH
Electrical/Electronic System F1
Engine Performance [X]
Suspension & Steering I I
Automatic Transmission/Transaxle I I
Engine Repair I I
Heating and Air Conditioning I I
Manual Drive Train & Axles I I
LPG Diagnosis and Repair [~]
LPG Maintenance fl
LPG Conversion/Installation I I
CNG Diagnosis and Repair
CNG Maintenance
CNG Conversion/Installation
General Service Technician Program*
nn
10/09
AUTOMOBILE INSTRUCTOR QUALIFICATION SHEET
Instructor Daniel Ming ASE ID# (required) OT2IX6S06MING(as it appears on your certificate)
Valid Until
12/2013
06/2015
06/2015
06/30/2013
06/30/2015
06/30/2015
06/30/2013
12/31/2013
(please print or type)
Current ASE Certifications;
A-l Engine Repair
A-2 Automatic Transmission/Transaxle
A-3 Manual Drive Train & Axles
A-4 Suspension & Steering
A-5 Brakes
A-6 Electrical/Electronic Systems
A-7 Heating & Air Conditioning
A-8 Engine Performance
F*l Light ̂ echtele»- Compressed Natural Gas •"• . - . . • . . . • . . . - . .^Indicates instructor certifications required for General Service Technician Program
Please indicate the areas taught by this instructor:
Brakes [X]
Electrical/Electronic System I I
Engine Performance CJ
Suspension & Steering [X]
Automatic Transmission/Transaxle I I
Engine Repair [""1
Heating and Air Conditioning [X]
Manual Drive Train & Axles I I
LPG Diagnosis and Repair []]
LPG Maintenance [3
LPG Conversion/Installation PI
CNG Diagnosis and Repair
CNG Maintenance
CNG Conversion/Installation
General Service Technician Program*
n
n
10/09
AUTOMOBILE INSTRUCTOR QUALIFICATION SHEET
Instructor Paul Spakowski ASE ID# (required) IV2KR5TM6SPAKO(please print or type) (as it appears on your certificate)
Current ASE Certifications; Valid Until
A-l Engine Repair 06/2013
A-2 Automatic Transmission/!ransaxle
A-3 Manual Drive Train & Axles
A-4 Suspension & Steering
A-5 Brakes
A-6 Electrical/Electronic Systems 6/30/11
A-7 Heating & Air Conditioning 12/31/10
A-8 Engine Performance 6/30/11
IM^ y • ' - . ' . . • . - 4 . - - : - . • • ' •indicates instructor certifications required for General Service Technician Program
Please indicate the areas taught by this instructor:
Brakes D
Electrical/Electronic System I I
Engine Performance [~1
Suspension & Steering [""1
Automatic Transmission/Transaxle I""]
Engine Repair |/<]
Heating and Air Conditioning I I
Manual Drive Train & Axles [""]
LPG Diagnosis and Repair ["]
LPG Maintenance Q
LPG Conversion/Installation O
CNG Diagnosis and Repair f"l
CNG Maintenance I I
CNG Conversion/Installation I I
General Service Technician Program* _10/09
AUTOMOBILE INSTRUCTOR QUALIFICATION SHEET
Instructor Kevin Sullivan ASE ID# (required) OW2NY5VL3SULLI(please print or type) (as it appears on your certificate)
Current ASE Certifications: Valid Until
A-l Engine Repair 06/2014
A-2 Automatic Transmission/Transaxle
A-3 Manual Drive Train & Axles
A-4 Suspension & Steering 6/30/2014
A-5 Brakes 6/30/2014
A-6 Electrical/Electronic Systems 6/30/2014
A-7 Heating & Air Conditioning
A-8 Engine Performance 6/30/2014
F-t' Light Veehicle^Compressed Natural Gas : . ' ^x-.•-•.•- . ...indicates instructor certifications required for General Service Technician Program
Please indicate the areas taught by this instructor:
Brakes d
Electrical/Electronic System [X]
Engine Performance Fl
Suspension & Steering I I
Automatic Transmission/Transaxle I I
Engine Repair I I
Heating and Air Conditioning [H
Manual Drive Train & Axles [U
LPG Diagnosis and Repair Q
LPG Maintenance f~]
LPG Conversion/Installation |~1
CNG Diagnosis and Repair [H
CNG Maintenance D
CNG Conversion/Installation [""]
General Service Technician Program* __^10/09
INSTRUCTOR TRAINING FORM
Instructors are required to attend a minimum of 20 hours per year of recognized industry updatetraining relevant to the areas in which their program is certified. Please list all industry updatetraining for the past year. Use a separate page for each instructor and attach to appropriateInstructor Qualification Sheet.
Instructor: Tom Broxholm
Date ofTraining
8/6/2010
8/5/2010
8/4/2010
8/3/2010
8/2/2010
7/30/2010
7/29/2010
7/28/2010
7/27/2010
7/26/2010
10/31/2009
10/30/2009
Provider Name
Honda
Honda
Honda
Honda
Honda
Chrysler
Chrysler
Chrysler
Chrysler
Chrysler
ATRA
ATRA
Course Name
Electrical, Manual & Automatic Trans
Electrical, Manual & Automatic Trans
Electrical, Manual & Automatic Trans
Electrical, Manual & Automatic Trans
Electrical, Manual & Automatic Trans
Elecrical, Auto Trans, Engine
Elecrical, Auto Trans, Engine
Elecrical, Auto Trans, Engine
Elecrical, Auto Trans, Engine
Elecrical, Auto Trans, Engine
Automatic Transmission
Automatic Transmission
Hours
8
8
8
8
8
8
8
8
8
8
8
8
10/09
INSTRUCTOR TRAINING FORM
Instructors are required to attend a minimum of 20 hours per year of recognized industry updatetraining relevant to the areas in which their program is certified. Please list all industry updatetraining for the past year. Use a separate page for each instructor and attach to appropriateInstructor Qualification Sheet.
Instructor: Rick Escalambre
Date ofTraining
1/8/2008
7/21/2008
4/25/2009
7/8/2009
7/20/2009
10/17/2009
4/23/2010
8/10/2010
8/13/2010
8/14/2010
Provider Name
Automotive Training Group
NACAT
CAT
Automotive Training Group
NACAT
CAT
CAT
Automotive Training Group
NYATTP
NYATTP
Course Name
Ford Engine Performance
Multiple Topics - See Certificate
Multiple Topics - See Certificate
Toyot, Lexus, & Scion
Multiple Topics - See Certificate
Multiple Topics - See Certificate
Multiple Topics - See CertificateNetwork Diagnostics and ModuleProgramming
Pressure Transudcers
Toyota Hi-Tech Update
Hours
7
13.5
6
7
15.5
5
6.5
7
4
4
10/09
INSTRUCTOR TRAINING FORM
Instructors are required to attend a minimum of 20 hours per year of recognized industry updatetraining relevant to the areas in which their program is certified. Please list all industry updatetraining for the past year. Use a separate page for each instructor and attach to appropriateInstructor Qualification Sheet.
Instructor: Dan Ming
Date ofTraining
6/2/2008
11/4/2008
11/5/2008
12/14/2008
12/15/2008
4/25/2009
4/25/2009
4/25/2009
10/17/2009
10/17/2009
10/17/2009
7/24/2009
7/24/2009
7/24/2009
7/24/2009
7/24/2009
7/24/2009
7/24/2009
7/24/2009
7/24/2009
7/24/2009
Provider Name
UOT
UOT
UOT
UOT
UOT
CAT
CAT
CAT
CAT
CAT
CAT
NACAT
NACAT
NACAT
NACAT
NACAT
NACAT
NACAT
NACAT
NACAT
NACAT
Course Name
553 Toyota Brakes Systems
302 Toyota Manual Trans/Transaxles
P302 Toyota Manual Trans/Transaxles
P453 Suspension Steering&Handling
453 Steering, Suspension&Handling
Electronic Transmission Diagnosis
Smart Key/Engine Control Operation
Advanced Mechanical Engine Set-Up
Super Flow
Automotive Training Group OBDII
Being More Effective with Email
A Little Bit of Electrical/Electronics
Evaporative Emissions Update
How Do I Prepare My Students
Advancing Web-Based LearningUnderstanding Root Cause of BeltFailures
Gas Analyzer and Amp Clamps
Best of "Material from MACS" 2009
Snag It/LogMeln, Part One
Snaglt/LogMelN, Part Two
Which Scan Tool Should I Buy?
Hours
16hrs.
16hrs.
Ihr.
Ihr,
16hrs.
Ihr.
Ihr.
2hrs.
2hrs.
l.Shrs.
l.Shrs.
1.75hrs.
1.75hrs.
1.75hrs.
1.75hrs.
1.75hrs.
1 .75hrs.
1.75hrs.
1.75hrs.
1.75hrs.
1.75hrs.
10/09
INSTRUCTOR TRAINING FORM
Instructors are required to attend a minimum of 20 hours per year of recognized industry updatetraining relevant to the areas in which their program is certified. Please list all industry updatetraining for the past year. Use a separate page for each instructor and attach to appropriateInstructor Qualification Sheet.
Instructor: Dan Ming
Date ofTraining
12/17/2009
4/24/2010
4/24/2010
4/24/2010
3/23/2010
Provider Name
UOT
CAT
CAT
CAT
ATG
Course NameE078 Tire Pressure MonitoringSystems
HVAC Evolution and Issues
Effective Email UseHybrid Vehicle Predict. Maint.Analysis & Diag.Advanced Security, Tire PressureMonitoring & Chassis Systems
Hours
Ihr.
Ihr.
Ihr.
2.25hrs.
8hrs.
10/09
INSTRUCTOR TRAINING FORM
Instructors are required to attend a minimum of 20 hours per year of recognized industry updatetraining relevant to the areas in which their program is certified. Please list all industry updatetraining for the past year. Use a separate page for each instructor and attach to appropriateInstructor Qualification Sheet.
Instructor: Kevin Sullivan
Date ofTraining
4/1/2007
7/16/2007
4/1/2008
5/1/2008
6/23/2008
6/18/2009
Provider Name
California Automotive Teachers
North American Council of AT.
California Automotive Teachers
Permatex
Train the Trainer
Perfect-Sky (Jack Rosebro)
Course Name
Brakes, Computer Control, Alignment
Various workshops
Hybrid, Honda E.P1, Power Point
Chemical Gaskets nad Sealants
OBDII Diagnostics
Hybrid Educator's Workshop
Hours
7
20
10
2
32
24
10/09
INSTRUCTOR TRAINING FORM
Instructors are required to attend a minimum of 20 hours per year of recognized industry updatetraining relevant to the areas in which their program is certified. Please list all industry updatetraining for the past year. Use a separate page for each instructor and attach to appropriateInstructor Qualification Sheet.
Instructor: Paul Spakowski
Date ofTraining
10/10/2009
10/10/2009
10/10/2009
10/10/2009
11/14/2009
11/14/2009
11/14/2009
10/16/2009
10/17/2009
Provider Name
Sunnen Corporation
Mahle Corp
Rottler Mfg.Auto Engine ReldrsAssociation
Edelbrock Corp
Competition Cam Corp
Auto Engine Rebuilders Assoc.
Scat Mfg. Corp
C.A.T. Confer. Cypress College
Course Name
Power Honing
Bearing Failure Analysis
Reboring New Materials
Internet Access for Technical Data
Cylinder Head Dev/Air Flow Manage
Developments in Valve Train Tech
New Pro Sis Software System
Crankshafts & Connecting Rod Assem
Various Seminairs
Hours
2.0
2.5
2.5
1.0
3.0
3.0
2.0
3.0
5.0
10/09
ADVISORY COMMITTEE LIST
Please list the names of all members of the Program Advisory Committee and indicate thecategory that each represents (a minimum total of Five (5) members is required). Instructors andadministrators of the program are not eligible to be advisory committee members. Committeemembers should represent a broad cross-section of the local industry in the area the programserves. Possible categories that advisory committee members might represent are:
Automobile TechniciansConsumer GroupsParents
NAME
Local EmployersFormer StudentsAutomotive Trainers
CATEGORY REPRESENTED
Jim Borton
Patrick Cadam
Dave Campbell
Nef Castro
Kris Cesena
Ray Chin
Dan D'Amico
Jon Fowkes
Frank Fragomeni
Zim Gwee
Mike King
Kirk Korenko
Mike La Torre
Michael McGee
Maher Nijem
Eric Sevim
Automotive Trainer
Local Employer
Consumer Group
Local Employer
Local Employer
Local Employer
Automobile Technician
Consumer Group
Local Employer
Former Student
Automobile Technician
Local Employer
Local Employer
Local Employer
Former Student
Automobile Technician
(ADD MORE SHEETS IF NECESSARY TO INCLUDE FULL COMMITTEE)
14 10/09
INTEGRATED ACADEMIC SKILLS RECOGNITION (OPTIONAL)• Note: For more information, refer to the Integrated Academic Skills Recognition page in
the Policies Section.
Program Name
Automobile Instructor(s) to be recognized:
Academic areas and instructors to be recognized:
English Instructor:
Mathematics Instructor:
Science Instructor:
Please answer 1 -6 on a separate page.
1. Briefly describe the coordination between the automobile and the academic department(s) forplanning, developing, and teaching integrated academic skills to automotive technicianstudents.
2. How often do the automotive and academic instructors meet to plan and coordinateclassroom activities?
3. Do automotive and academic instructors team teach automotive students? If so, describe theactivities and responsibilities of the instructors.
4. Are automotive and academic instructors actively involved with automotive studentorganizations, activities, or competitions? If so, describe the activities.
5. Are students given academic credit for their technical classes?
6. If applicable, describe how the Integrated Academic Skills manual for AutomobileTechnicians was used to integrate academic and technical skills student activities.
10/09
PAYMENT WORKSHEET
Please include the following applicable fees with your automobile recertificationapplication. Payment must be included for your application to be processed. Forms ofpayment include purchase order, check made out to NATEF, or credit card (MC/VISA, orAmerican Express). Please indicate method of payment below.
Skyline CollegeSchool Name
3300 College DriveSchool Address
San Bruno CA 94066City State ZipCode
Application Fee: $315.00(certification and recertification)
*On-site Team Packets:Recertification (3 @ $65 each) $195.00
$510.00 total to be enclosed
* If submitting multiple applications at the same time (GM ASEP, etc)please call the NATEF office for on-site team packet total to be enclosed.
Method of payment
Purchase Order I I please include copy ofPO
Check D
MasterCard/Visa/AMEX [X]
5569190001169979Card Number
J?00/201 1 _ ^rx^/s <& /, <^/-; ; <3Exp. DateRick Escalambre, San Mateo County CCDName as it appear^on card
Cardholder signature
^Payment of the ETL honorarium and the ETL expenses must be made directly tothe ETL. Payment or arrangements for payment must be made at the time of
the on-site visit. Do not send ETL payments to NA TEF
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