Last Name

Phone Number

CONTACT INFORMATION

First Name

Ferris Email Address

Student Number

PROGRAM INFORMATION

Which program are you seeking entrance into?

Elementary Education

Secondary Education

Your Major Your Minor(s)

Your certification band

PK-6 PK-3 3-6

DEGREE PLAN

I have met with my advisor and created a plan in MyDegree for a semester of student teaching. Yes

No

Anticipated semester of student teaching

APPLICATION FOR LEVEL 2 EDUCATION COURSES

Undergraduate Teacher Certification Program

APPLICATION REQUIREMENTS

Check all that apply to you.

I have officially declared my major and/or minor(s). I have completed at least 30 hours of documented experience with children.

(This requirement may be met with level one course work.) I have completed at least 35 hours of coursework including

• A Communication course

• MATH 114 or higher

• One Natural Sciences course

I have completed Implicit Bias Training as part of my level 1 coursework EDUCATION COURSES

What is your cumulative GPA?

I am aware (or have taken and received) a grade of C or better with a minimum 2.5 GPA and have no more than one repeat in any School of Education course (EDUC, EDCD, EDLA, EDPE, EDGP, ECTE).

Yes

No

Course Deviation (if applicable) Grade

EDUC 161

EDCD 112 or EDUC 251

EDCD 115

EDCD 211 or EDUC 289

EDUC 261

CAEP Accreditation Testing Requirements

I have met the CAEP Accreditation Testing Requirements by: (check all that apply) SAT Evidence Based Reading/Writing score minimum of 510 SAT Mathematics score minimum of 510

ACT Reading score minimum of 22

ACT Mathematics score minimum of 22

ACT Writing score minimum of 7

Using alternative course grade pass for one or more of the requirements

• ENG 150 and 250 with grade of B or better (writing test requirement)

• MATH 114 or higher with grade of B or better (math test requirement)

(MATH 208, 209, 307 do not count for this requirement)

• Any science course with a grade of B or better (reading requirement) REQUIRED ATTACHMENTS

Check all that apply.

I have signed and agree to abide by the attached Professional Behaviors Statement. I have signed and attached the Release of Student Information form. I have completed and submitted a DHS clearance form to the local DHS office. I have read, signed and attached the Criminal History Disclosure Form. I have read, signed and attached the Student’s Liability/Medical Responsibility form. I have read, signed and attached the Field Placement Taping Agreement. FUTURE REQUIREMENTS

Initial below if you agree to all of the following requirements.

• I understand that I must follow the host school’s policy regarding criminal background checks for visitors, volunteers and/or students.

• I understand that I may be required to show a TB test documentation dependent on the school district I am placed in.

• I understand that I need current First Aid and CPR certification in order to be recommended for teacher certification to the Michigan Department of Education.

• I understand that I must take and pass the MTTC Subject Matter Exam (Secondary Major or Elementary Education) before I may begin my student teaching assignment.

• I understand that if I have a vocational major/minor (i.e., Business, Automotive, etc.) I must contact the Teacher Certification Officer at 231-***-****. 4000 hours of work experience must be documented and approved prior to Student Teaching/Experienced Teacher Review.

Initial here if you agree.

SIGNATURE PAGE

Your Signature Today’s Date

Advisor’s Signature Today’s Date

Contact this candidate