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Provide copy to the School of Education office." }, { "id": "p1.6", "order": 56, "type": "text", "bbox": { "l": 34.56, "t": 277.2, "r": 394.56, "b": 265.68 }, "text": "Completed Assessment of Professional Dispositions, Values, & Behaviors form" }, { "id": "p1.7", "order": 57, "type": "text", "bbox": { "l": 34.56, "t": 265.2, "r": 295.2, "b": 253.2 }, "text": "(1 filled out by you, and 2 others as indicated on form)." }, { "id": "p1.8", "order": 58, "type": "text", "bbox": { "l": 34.8, "t": 254.16, "r": 495.84, "b": 242.64 }, "text": "25 field experience hours documented in KFETS and copies of field verification forms submitted to SOE." }, { "id": "p1.9", "order": 59, "type": "text", "bbox": { "l": 34.8, "t": 242.64, "r": 286.32, "b": 229.92 }, "text": "□ Autobiographical Sketch submitted with application.", "children": [ { "id": "p1.9.1", "order": 60, "type": "form_field", "bbox": { "l": 34.8, "t": 242.64, "r": 46.8, "b": 230.64 }, "text": "", "attrs": { "field_kind": "checkbox", "label": "□ Autobiographical Sketch submitted with application.", "source": "glyph_estimate", "bbox_estimated": true, "label_source": "parent_text", "label_ref": "p1.9", "text_offset": 0, "text_span": 1 } } ] }, { "id": "p1.10", "order": 61, "type": "text", "bbox": { "l": 70.08, "t": 207.84, "r": 404.16, "b": 196.32 }, "text": "Successful completion of TEP interview, scheduled by School of Education office." }, { "id": "p1.11", "order": 62, "type": "text", "bbox": { "l": 33.36, "t": 172.8, "r": 576.96, "b": 91.68 }, "text": "I authorize the University to submit confidential credentials to the Teacher Education Committee for evaluation to determine my compliance with Kentucky State University Standards and regulations for admission to the TEP. I understand that if I am admitted to the TEP, it is my responsibility to maintain credentials that are in compliance with University and Kentucky standards and regulations; and if I plan to teach in a state other than Kentucky, I also have to be in compliance with that state's standards and regulations. Furthermore, I certify that answers submitted are true and accurate to the best of my knowledge, for falsified statements on this application or other documents, unsatisfactory academic progress, failure to maintain appropriate credentials, or disciplinary action by the university against me, shall be considered sufficient cause for the Teacher Education Committee to expel me from the TEP." }, { "id": "p1.12", "order": 63, "type": "heading", "bbox": { "l": 34.32, "t": 70.32, "r": 78.24, "b": 57.84 }, "text": "Signature:", "children": [ { "id": "p1.12.1", "order": 64, "type": "form_field", "bbox": { "l": 36, "t": 71.7119, "r": 282.13, "b": 58.4252 }, "text": "", "attrs": { "field_kind": "text", "label": "Signature:", "source": "blank_line", "label_source": "parent_text", "label_ref": "p1.12" } } ], "level": 3 }, { "id": "p1.13", "order": 65, "type": "text", "bbox": { "l": 34.56, "t": 69.6, "r": 495.36, "b": 58.08 }, "text": "___" }, { "id": "p1.14", "order": 66, "type": "text", "bbox": { "l": 322.08, "t": 69.6, "r": 492.72, "b": 58.32 }, "text": "Date:_____", "children": [ { "id": "p1.14.1", "order": 67, "type": "form_field", "bbox": { "l": 324.07, "t": 71.7119, "r": 490.6017, "b": 58.4252 }, "text": "", "attrs": { "field_kind": "text", "label": "Date:_____", "source": "blank_line", "label_source": "parent_text", "label_ref": "p1.14" } } ] } ], "excluded_furniture": { "first": [], "last": [] } }