Submit this Application for Admission, as part of your complete application packet, by February 1 for fall admission or by September 1 for spring admission. All requirements must be met by the application deadline. Admission decisions are made by the Teacher Education Committee the semester prior to the student teaching/practicum semester.
Candidate: ___ Date of application: ___
Student ID: ___ GPA: ___ Telephone number(s): ___
Preferred mailing address: ___
Undergraduate major: ___ Date of admission to TEP: ___
Remaining ESP courses (attach Student Guide Sheet): ___
If Certified: Teacher certification (date, field): ___
Student teaching (dates, district, school, classroom setting, Cooperating Teacher):
___
KTIP (dates, district, school, classroom setting, Resource Teacher): ___
Provide dates and copies to verify the following:
Praxis II exam date(s) & score(s): ___
Federal criminal history report: _____ NEA membership year: _____
Medical exam with TB test (date): _____
Signed & dated Professional Code of Ethics for Kentucky School Certified Personnel (attached): ___
Signed & dated Character and Fitness statement (attached): _____
Employer: ___
Official job title: ___
Dates of employment in this position: ___
Job responsibilities: ___
Title: _____
Supervisor: Name: _____ E-mail: _____
Revised Spring 2018