APPLICATION PROCESS:
1. Applicants MUST return the application and ALL documentation by the close of business on or prior to October 1, 2014 for a Generalist EC-6 or 4-8 Cycle I applicant or December 12, 2014 for a Generalist EC-6 or 4-8 Cycle II applicant or March 3, 2014 for a secondary applicant unless otherwise instructed by the program supervisor.
2. Applicants are screened for the minimum qualifications:
a. Bachelor’s degree with a minimum 2.75 grade point average.
b. Minimum 2.75 grade point average in the coursework that qualifies you for the certification area that you selected.
c. Additional qualifications may be required by SBEC that may be added after this application and associated materials have been produced. Check with the Region III EPP staff to see if there are any new requirements that are not specified above.
3. Specific certification area qualifications:
a. Generalist EC-6 and Special Education EC-12: Must have 24 semester hours in a combination of English, math, science, and social studies with a GPA of 2.75 or above; must have at least 3 semester hours in each area or pass the related TExES Content test.
b. Generalist 4-8: Must have 36 semester hours in a combination of English, math, science, and social studies with a GPA of 2.75 or above; must have at least 6 semester hours in each area, or pass the related TExES Content test.
c. Secondary Areas: Must have a minimum of 24 semester hours in a specific content area (i.e. English, math, science, social studies, music, Spanish, etc.) with at least 12 of the 24 semester hours being upper level (junior-senior classification) coursework with a GPA of 2.75 or above or pass the related TExES content test.
INFORMATION TO INCLUDE Please check the appropriate boxes below to indicate
WITH APPLICATION: which items you are attaching to your application.
This completed application packet includes the Criminal Record Check Form, TExES Approval Form, Demographic Sheet, and Interview Agreement.
Official transcripts from each college/university you have attended. Photocopies are not acceptable. Foreign transcripts must include one official translation and course-by-course evaluation from an approved credential evaluation service (i.e., SpanTran)
The Nonrefundable Application Fee of $100. Applications will not be processed without payment. Make checks payable to Region III ESC EPP. MasterCard and VISA are accepted with appropriate documentation and ID. Checks and credit cards returned for any reason will have a $35 return fee added and cash only will then be accepted.
I hereby affirm that all information provided is true and accurate to the best of my knowledge. I also understand that information contained in this application that later proves to be false or incomplete, shall result in significant cause for immediate dismissal from the Region III ESC Educator Preparation Program. I understand that acceptance into the EPP does not guarantee employment by a school district. I hereby authorize Region III ESC EPP to release application information for employment purposes to local school districts.
Equal Opportunity Policy
Region III ESC will not discriminate in its educational programs, activities, or employment practices, based on race, color, national origin, sex, sexual orientation, disability, age, religion, ancestry, union membership, or any other legally protected classification. Announcement of this policy is in accordance with state and federal laws, including the Title IX of the Educational Amendments of 1972, Sections 503 and 504 of the Rehabilitation Act of 1973, and the American Disabilities Act of 1990. The following person has been designated to handle inquiries regarding the non-discrimination policies: Deputy Director of Programs and Services (361) 573-0731.
Note: The contents of this application are not intended to create any contractual or other legal rights and are designed solely as a guide for
applicants to the Educator Preparation Program.
DATE: Legal Signature of Applicant:
RETURN APPLICATION AND RELATED DOCUMENTS TO:
APPLICATION DEADLINES Educator Preparation Program
Tuesday, October 1, 2014 (EC-6 or 4-8) Cycle I Region III Education Service Center
Friday, December 12, 2014 (EC-6 or 4-8) Cycle II 1905 Leary Lane
Monday, March 2, 2015 (Secondary) Victoria, TX 77901
EDUCATOR PREPARATION PROGRAM APPLICATION
Region III considers all applicants for the Educator Preparation Program without regard to race, religion, sex, age, national origin, marital status, disability, and veteran military status, the presence of a medical condition or any other legally protected status.
Date of Application:
Please check the certification area for which you are applying (check one box only).
Generalist EC-6 English Language Arts 8-12 Business Education 6-12
Generalist 4-8 Mathematics 8-12 Special Education EC-12
Bilingual Generalist EC-6 OR 4-8 Science 8-12 Life Science 8-12
Gen. EC – 6 & Sp. Ed. EC - 12 Music EC-12 Physical Science 8-12
Gen. 4 – 8 & Sp. Ed. EC - 12 Physical Education EC - 12
History 8-12 Art EC-12
Social Studies 8-12 Agriculture Science 8-12
Other (Specify):
* First year teachers MUST be “highly qualified” at whatever campus level they will teach.
Instructions: Please complete the application fully. If a question is not applicable or not appropriate, enter an N/A (not applicable).
(Please Print)
Name:
First M.I. Maiden Last SSN / TEA ID#
Address:
Street City State Zip
Home Phone: ( ) Work Phone: ( )
E-mail: Are you eligible for employment in the U.S.? ___YES ___NO
Cell Phone: ( )
EDUCATION
Your Degree: _____ Bachelor’s Major ______Institution ______
_____ Master’s Major ______Institution ______
_____ Doctorate Major ______Institution ______
Official transcripts from all institutions attended where college credit has been attained must be received before the application continues to the GPA process. (“Official” transcript is defined as a transcript provided to Region III ESC in a sealed (unbroken) envelope from the institution of higher education dated during the current EPP application cycle.)
List below all other institutions of higher education that you have attended.
Institution City and State
Have you ever applied to or been accepted into another Alternative Certification Program? YES NO
If yes, to which region/university/private program did you apply?
Were you accepted? YES NO
If yes, have you successfully completed the program and/or passed the ExCET/TExES? YES NO
Have you ever taught on a probationary certificate or an emergency permit under a deficiency plan?
YES NO
If, yes, give the name of the school district, city, state, grade/subject which you taught, and the dates:
If “Yes” you must supply the program with an official teacher service record to determine if you have any certificate time remaining in order to complete the program internship.
PERSONAL INFORMATION
The State Board of Educator Certification (SBEC) requires that each applicant to an Alternative Certification program be subject to a criminal record check. Have you ever been convicted of, pleaded guilty or no contest to, or received probation, suspension, or deferred adjudication (other than traffic tickets) for a felony, misdemeanor, or any other offense involving moral turpitude (including, but not limited to, theft, rape, murder, swindling, and indecency with a minor)? _____ YES _____ NO
The Region III Deputy Director of Programs and Services reviews the result of the criminal history report and determines whether the applicant is accepted. If you have reason to believe you may be ineligible for educator certification due to a conviction or deferred adjudication for a felony or misdemeanor offense, you can contact your local law enforcement agency to request a personal report or visit the following link: http://www.tea.state.tx.us/index2.aspx?id=2147486679.
MILITARY SERVICE
Have you served in the MILITARY? YES NO Branch of Service:
Are you currently a member of the Reserves or the National Guard? Yes NO
THREE PROFESSIONAL REFERENCES
Please list three individuals and their addresses that you would like to use as professional references. Please choose individuals who will be able to write a reference for you that can evaluate your work experience, knowledge of subject matter, familiarity of your work in relation to young people, and the extent they feel you will be successful as a teacher in your chosen certification area.
Name Address/City/State Zip Business/Home Phone Title/Relationship
______
______
______
EMPLOYMENT
List below your full time work experience with your most recent experience first.
Are you presently employed? YES NO
1. Date of Employment: From: To:
Name of Employer:
Address/City/State/Zip
Business Phone: Name of Immediate Supervisor:
Title of Position You Held: Reason for Leaving:
Description of work performed:
2. Date of Employment: From: To:
Name of Employer:
Address/City/State/Zip
Business Phone: Name of Immediate Supervisor:
Title of Position You Held: Reason for Leaving:
Description of work performed:
Required Tests
Please list your basic skills test scores you have completed. Submitting a copy of your scores or a transcript that reflects your scores will provide proof of test scores. The E. P. P. reserves the right to require retesting, if deemed necessary.
Test name: ______Reading: ______Writing: ______Math: ______
Verification Check
Please check all boxes to verify the information requested. (Applicants will not be considered as officially accepted until all application information is provided):
I currently hold a Bachelor’s degree or higher from a regionally accredited institution and acknowledge that official transcripts must be provided directly to Region III EPP from all institutions where college credit was received.
I have taken a basic skills test and my scores are attached. (I understand that if I have not taken a basic skills test, I will register to take the THEA Test as soon as possible – before being allowed to take any TExES Content Test.)
I will request reference letters, preferably written on letterhead and with legible written signatures, by three individuals and have them returned to Region III EPP.
I have submitted the criminal record check consent form with this application. (I understand that once my criminal record check has cleared, observation forms will be sent to me with directions for completing the required observation hours.)
I understand that is it is my responsibility to return my application and all appropriate documentation to the Region III EPP by the necessary deadline(s) or my application may not be accepted.
I have attached the $100 application fee. (If paying by check, make payable to Region III ESC EPP [MC or VISA accepted]. If a check is returned for insufficient funds, additional fees may be assessed and all future payments must be by cash or money order and application status may be affected until the fee is paid in full.)
I hereby affirm that all information provided in this application is true and accurate to the best of my knowledge. I also understand that employment based upon information contained in this application that later proves to be false or incomplete may result in sufficient cause for my immediate dismissal from the Region III Educator Preparation Program. I understand that formal acceptance into the EPP is contingent upon employment in a public, charter, or accredited private school system and completion of entrance requirements. I hereby authorize Region III to conduct a criminal history background check.
Upon acceptance into the EPP, your signature below indicates you agree to meet all requirements of the program and are willing to commit your time to the intense pre-service training and ongoing training.
day of , 20
Legal Signature of Applicant
NOTE: The content of this application is not intended to create any contractual agreement or imply other legal rights and are designed solely as a guide for applicants to the Educator Preparation Program.
The Educator Preparation Program is subject to change without notification to meet the needs of the program and to comply with federal and/or state regulations. Rev. 6/20/2014
Criminal Record Check
Confidential*
The State Board of Educator Certification (SBEC) requires that each applicant to the Alternative Certification program be subject to a criminal record check. Have you ever been convicted of, pleaded guilty to, no contest to, or received probation, suspension, or deferred adjudication (other than traffic tickets) for a felony, misdemeanor, or any other offense involving moral turpitude (including, but not limited to theft, rape, murder, swindling, and indecency with a minor)?
Circle Answer: Yes or No
Please print:
Name: ______
Last First Middle
Drivers License # & State: ______
Date of Birth: ______
I understand that the information I am providing will be solely used to determine eligibility for the Region III E. S. C. – Educator Preparation Program.
Signature Date
TExES APPROVAL FORM
______
(Application Date)
Please fill in the information below with your most current information:
______-______-______
(Social Security Number) (TEA ID #)
(Completed by EPP Staff ONLY!)
(Last Name) (Maiden Name) (First Name) (Middle Name)
(Date of Birth)
(Email address - The address to which all information from TEA & SBEC is to be sent)
(Do Not Complete Anything Below This Line – To Be Completed by ESC ONLY)
(Acceptance date: Completed by EPP Staff ONLY!)
(Route to Certification: Completed by EPP Staff ONLY!)
(Testing Code/Test Name: Completed by EPP Staff ONLY!)
(Approval to Test: Completed by EPP Staff ONLY!)
TITLE 2 HIGHER EDUCATION ACT
Demographic Information
The Title 2 Higher Education Act requires each institution to provide certain information and data on each candidate applying for certification as a teacher. Please complete the following information and return to the Educator Preparation Program. This information will be kept confidential and will become a part of your records for our program. The information will be shared with no one but will become a part of the Title 2 Report that is required by United States Department of Education.
Name: ______
First Middle Maiden Last
Date of birth: ______/______/______
Month Date Year
SSN or TEA ID Test Number: ______
Complete each of the sections below by circling “Yes” or “No” for each group:
Ethnicity:
Hispanic / Spanish of any race: Yes No
Race:
American Indian or Alaska Native: Yes No
Asian: Yes No
Black or African American: Yes No
Native Hawaiian or Other Pacific Islander: Yes No
White: Yes No
Region III ESC – EPP 4 / 24 / 10
E. P. P. Interview Agreement
I understand that an interview is part of the process for acceptance into the