All Level Education Certification Programs (PK/K—12)
CCSU School of Education and Professional Studies
203 Henry Barnard Hall; Phone: 860-832-2125Undergraduate and Post Baccalaureate certification students must be admitted to the Professional Program for Teacher Certification before they can take or pre-register for professional program courses.
Application Submission deadline (or next regular day of classes if date falls on a weekend or holiday):
Fall Semester: September 10 Spring Semester: February 10
Complete applications may be submitted between the start of the semester and the application deadline.
Please print or type
Last Name (please print) CCSU ID
First Name Middle Initial Former Last Name(s)
Mailing Address Apt. # City/State/Zip Email EMAIL WILL BE SENT TO
YOUR CCSU EMAIL ACCOUNT
Home Phone Cell Phone Date of Birth (MM/DD/YY) Gender £ Female £ Male
Ethnicity/Race (Optional) Ethnicity (check one) £Hispanic or Latino £ Not Hispanic or LatinoRace (mark all that apply) £American Indian / Alaska Native £Asian £Black / African American £Native Hawaiian / Pacific Islander £White
£ First Time £ Reapplication Semester previous application submitted: ______
Application Use from old application: £Essay £Recommendations £Praxis scores/waiver £Transcripts £Experience forms
Entering Level
£ Undergraduate £ Graduate/Post Baccalaureate
£ I am or will be a graduate of a Connecticut Community College Pathways to Teaching Careers program.
Program
£ Art Education, PK-12 £ Physical Education, PK-12 £ TESOL, PK-12 £ Music Education, PK-12
£ Special Education, K-12 £ Technology and Engineering Teacher Education (PK-12)
Praxis Tests Students receiving disability or non-native English speaker accommodations should contact the Assistant Dean for application accommodation information.
£ PRAXIS Waiver–attach a copy of official waiver letter. £ PRAXIS CORE Tests–you will be contacted if your scores are not on file.
Note: if you passed all three Praxis I tests by 9/1/2014, you may use them for this application. They will be accepted for certification until 7/1/2019.
Institutions Attended (Except CCSU)
List all colleges and universities you have attended (undergraduate and graduate) and attach official transcripts from all except CCSU. Transcripts submitted to other CCSU offices cannot be used. Use a separate piece of paper if you need more space.
College/University / City/State / Month/Year Attended / Undergraduate/Graduateto
toto
Statement of Criminal Background
1. Have you ever been convicted of any crime, excluding minor traffic violations? / £YES £NO2. Have you ever been dismissed for cause from any position? / £YES £NO
3. Have you ever surrendered a professional certificate, license, permit or other credential (including, but not limited to, an education credential); had one revoked, suspended, annulled, invalidated, rejected or denied for cause; or been the subject of any other adverse or disciplinary credential action? / £YES £NO
4. Is there any other legal issue/pending case that might appear on a background report that you think you should discuss with the Assistant Dean? For instance, you must pass a criminal background check to participate in field experiences. Arrests and accelerated rehabilitation programs show on the report until the case is disposed or rehabilitation complete. These can impact our attempts to find field placements. / £YES £NO
NOTE: If you answer “YES” to any of the above questions, you will be asked to meet with the Assistant Dean and submit a signed statement explaining each incident with applicable court or administrative record(s).
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Application to the Professional Program — Pk/K-12 All Level Certification Programs
Name ______CCSU ID: ______
Requirements for Admission
(Please read all instructions and requirements completely)
Submit all documents listed below and meet all specific requirements listed in Program Specific Prerequisites and Requirements;
· Undergraduate students— completed 45 hours total, of which 15 hours are at CCSU; or Post-Baccalaureate Certification students—bachelors degree, admission to graduate studies, and completed or enrolled in 6 hours at CCSU, unless stated otherwise in Program Specific Prerequisites and Requirements.
· Overall cumulative grade point average (GPA) of 2.70 at CCSU and a cumulative 2.70 GPA on all undergraduate coursework taken at all institutions. Additional content area GPA requirements are listed in Program Specific Prerequisites and Requirements;
· Pass an interview with a faculty team conducted AFTER the application is submitted, demonstrating an acceptable standard of knowledge, skills, and professional dispositions important to effective teaching performance.
· NOTE: CCSU reserves the right to seek additional information from faculty and others concerning candidates for admission.
All students submit (Please mark if required document is included in application materials): Note: We recommend that transcript and waiver/ testing requirements be done 2-3 months before the application deadline to allow time for processing.
q Completed application, signed and dated, with name written on all documents;
q Praxis Core waiver letter from Connecticut Department of Education attached to the application or Praxis Core test scores reported directly to CCSU. Praxis scores should be on file with CCSU when application is submitted. You will be notified if scores are not on file. You are responsible for submitting scores even if you previously asked ETS/Praxis to report scores to CCSU. Applications will not be processed without the Praxis requirement met. Students receiving disability or non-native English speaker accommodations should contact the Assistant Dean for application accommodation information.
q Official non-CCSU transcripts from all institutions attended even if coursework did not transfer to CCSU. Have transcripts sent directly to you and submit them with the application. “Issued to Student” transcripts with official signatures and/or on transcript paper may be submitted. The Assistant Dean orders CCSU transcripts.
q Two recommendations (signed originals) related to your ability to work with children and adults from professionals who know your work well. Forms available in rack outside 203 Barnard. Also see Program Specific Prerequisites and Requirements for additional recommendation requirements;
q Essay demonstrating a command of the English language, describing why you want to teach and enroll in the Professional Program for Teacher Certification, emphasizing experiences relevant to teaching. (see Program Specific Prerequisites and Requirements for additional essays required by some programs);
q Course and work schedule indicating availability for interviews.
q Any program specific requirements listed under Program Specific Prerequisites and Requirements including requested grades.
Graduates/Post-Baccalaureate Certification Students should also submit:
q Photocopies of the Graduate School admission letter and the official Planned Program Worksheet (with appropriate signatures).
Submit complete application materials in person, not by mail, to the Assistant Dean, School of Education and Professional Studies, 203 Barnard Hall. INCOMPLETE APPLICATIONS MAY NOT BE PROCESSED. If you have questions or issues, contact the Assistant Dean, School of Education and Professional Studies before the application deadline.
Program Specific Prerequisites and Requirements
PK-12 Art Education Requirements
Undergraduate & Graduate
· Minimum 3.00 in content area.
· Pass department portfolio review.
· Successful completion of the following courses. Indicate grade earned in each or write “Now” if you are currently enrolled. If using a transfer course, indicate course. Courses must be completed before full admission will be granted.
ART 112 ______ART 113 ______ART 120 ______PSY 236 ______
· Current enrollment or completion of EDTE 314 and ART 301 with a grade of C or better. Indicate grade earned. Write “Now” if you are currently enrolled. Must be completed before Professional Program admission will be granted.
EDTE 314_____, ART 301_____.
PK-12 Music Education Requirements
Undergraduate & Graduate
· Pass at least 60% of piano proficiency exam.
· Pass sophomore review.
· Successfully complete the following courses before admission to the Professional Program. Indicate grade earned: Write “NOW” if currently enrolled. Courses must be completed before full admission will be granted.
MUS 101 ______MUS 216 ______MUS 222 ______MUS 278 ______
· Current enrollment or completion of EDTE 314 and MUS 310 with a grade of C or better. Indicate grade earned. Write “Now” if you are currently enrolled. Must be completed before Professional Program admission will be granted.
EDTE 314______, MUS 310______.
PK-12 Physical Education Requirements
Undergraduate & Graduate
· Minimum of 3.00 GPA on all courses in the Physical Education major.
· Successfully complete EXS 213 (formerly PE 213), PE 111 & 2 skills courses in the Physical Education major BEFORE APPLYING TO THE PROFESSIONAL PROGRAM.
· Current enrollment or completion EDTE 314 and PE 299 with a grade of C or better. Indicate grade earned. Write “Now” if you are currently enrolled. Must be completed before Professional Program admission will be granted.
EDTE 314_____, PE 299_____.
K-12 Special Education Requirements
Graduate Only
· Pass an essay written at interview.
· Total 40 hours of field experience in public school settings including 30 hours in regular education and 10 hours in a special education setting, documented on the Special Education Department Experience Form in rack outside of Barnard 203. Non-public special education settings may be substituted with prior department approval.
PK-12 Technology Education and Engineering Teacher Education (K-12)RequirementsUndergraduate
· Non-transfer students: successful completion or current enrollment in 15 hours in TE, MFG, EMEC, GRT or TC courses taken at CCSU.
· Transfer students: successful completion or current enrollment in 9 hours in TE, MFG, EMEC, GRT, or TC courses taken at CCSU.
Graduate
· Successful completion or enrollment in 6 hours in TE, MFG, EMEC, GRT, or TC courses taken at CCSU.
Undergraduate and Graduate
· Current enrollment or completion of EDTE 314 and TE 299 with a grade of C or better. Indicate grade earned. Write “Now” if you are currently enrolled. Must be completed before Professional Program admission will be granted.
EDTE 314______, TE 299_____.
Graduate Only
· Successful completion of 15 credits of TESOL/Linguistics courses including LING 496 (formerly ENG 496), at time of application.
Statements of Understanding
Read Before Signing!
I understand that to be accepted into the Professional Program, complete the Professional Program, and obtain a recommendation from CCSU for Connecticut certification, I must demonstrate the following:
· Professional attitudes and attributes appropriate to a teacher.
· Conduct that demonstrates appropriate professional behavior and shows realization that actions reflect directly upon the status and substance of the profession.
· Confidentiality of all information concerning colleagues and students obtained in the educational process.
· Integrity and honesty in written and verbal communication, documentation, and coursework.
· Adherence to the Connecticut Code of Professional Responsibility for Teachers.
I further understand that the Dean of the School of Education and Professional Studies may revoke my admission if:
· My cumulative GPA drops below 2.70.
· I demonstrate unprofessional behavior or an inability to respond appropriately in various contexts that affect my performance as a teacher.
· I falsify or misrepresent any documentation or information for programmatic, academic, or professional qualification/competency purposes.
· I demonstrate unacceptable performance in field experiences or student teaching.
· I fail to achieve an acceptable level on required School of Education and Professional Studies assessments.
· Other due or sufficient cause.
I further understand that
· Connecticut law requires that I complete a fingerprint-based criminal background check before participating in field experiences or student teaching and that I am responsible for obtaining the background check.
· any pending incident, including arrests and accelerated rehabilitation, may appear on my criminal background report and result in school districts not accepting me for field experiences or student teaching.
· if I have been convicted of a crime, dismissed for cause, or surrendered a professional credential, I might not be admitted to the Professional Program, may be unable to participate in field experiences or to student teach, or may be ineligible for CCSU’s recommendation for certification. This decision is at the discretion of the Dean of the School of Education and Professional Studies. Furthermore, I understand that even if I receive the CCSU recommendation for certification, the Connecticut State Department of Education may not grant me certification.
· if I am arrested after admission to the Professional Program, I must report the incident to the Assistant Dean of the School of Education and Professional Studies within 5 days of the incident.
· if I fail to pass the background check, I may be unable to complete my chosen program at CCSU. I understand that the University is not responsible for my inability to complete my chosen degree or certification program.
I further understand that
· It is my responsibility to provide up-to-date, official transcripts (transcripts marked “issued to student” are acceptable) from all colleges/universities that I have attended and that transcripts submitted to other CCSU offices cannot be used by the SEPS Assistant Dean’s Office.
· If CCSU does not have my Praxis Core scores on file, I am responsible for submitting my score report to the Assistant Dean even if I previously requested that test scores be sent to CCSU.
· All application materials become property of the Office of the Dean of Education and will not be returned.
I understand and agree to abide by the above Statements of Understanding. I attest that the information provided by me in this application contains no willful misrepresentation or falsification and that all of the information given by me is true, complete and accurate. I understand that this information may be verified and that any misrepresentation or falsification may result in the rejection of my application. I understand that admission may be revoked if I fail to continue to meet program requirements.
Signature / DateThis page intentionally left blank.
CCSU OFFICE USE ONLY
GRADE POINT AVERAGE is found on the Summary Report
COMMENTS
DEPARTMENTAL REVIEW & EVALUATION DECISIONS
GPA in Content/Major Area, calculated on a minimum of 15 credits in the major: ______
Essay: Please P check evaluation result below and attach completed essay criteria/score sheet.
Pass ______Not Passed ______Passed on Redo ______
Name of Essay Reviewer 1 Name of Essay Reviewer 2
Comments:
Interview: Please P check evaluation result below and attach completed interview criteria/score sheet.
Pass ______Not Passed______Passed on Redo ______
Name of Interviewer 1: Name of Interviewer 2:
Comments:
Additional Comments:
RECOMMENDATION FOR PROFESSIONAL PROGRAM
Department Chair’s or Coordinator’s Signature / Date / AdmitR / Not ready to apply
R / Defer
R / Reject
R / Reasons: (Please word reason for not ready, deferral or rejection the way it should appear in the student’s letter.)
Original Application
Dean’s Signature
Original Application
Deferral Clearance
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