APPLICATION FOR ADMISSION

TO

THE TEACHER EDUCATION PROGRAM

WORD PROCESS THIS FORM (revised Fall ‘14)

Name______Date______

LAST MAIDEN FIRST MI

Email______Viterbo student ID#______

Local address______Phone______

Major______Minor______Year in university (circle) F S Jr. Sr. Cumulative GPA (from degree audit) ______

PRAXIS I/PPST / Date Passed______/ Date Passed______/ Date Passed______
Reading Score______/156 / Math Score______/150 / Writing Score______/162

If not taken by time of application, passing scores must be received within one month of the due date for which you are applying. When is your scheduled date?

OR, one of the following college entrance exams taken within the last five years

ACT – Composite Score of /23; with a minimum score 20 in each subtest - English /20,

Math /20, and Reading /20 Date Taken

SAT – Composite Score of / 1070; with a minimum score of /450 Math and /450 Verbal

subtests. Date Taken

GRE – Composite Score of /298; with a minimum score of /145 on the Math subtest. Date Taken

Student Signature______Date______

Recommendations—Evidence of reliability and dependability

Secure the signature of faculty members in whose classes you have been enrolled, or with whom you have worked in co-curricular activities. One signature must be that of a faculty member in your major department.

Faculty member who has been your instructor / Relationship to Student
(Sign if you feel student is reliable and dependable)
1. / / ______
2. / / ______
3. / / ______

Major Department Comments

Major Department Chair______

(Indicates reliability, dependability, and potential for teaching.)

Field Experience Review Comments

Director of Teacher Education______

ADMISSION TO TEACHER EDUCATION

Double space your word-processed answers to the two questions below and attach to this application. Give substantive, reflective answers. (You completed this assignment in EDUC 255, Professional Issues in Education.) You must submit the corrected final copy.

Why do you want to be a teacher?

What qualities and skills make a teacher effective?

Application Form—WORD PROCESS THIS FORM

Updated Degree Plan

Attach a copy of your updated Degree Plan completed in EDUC 255, Professional Issues in Education.

Updated Curriculum Requirements Checklist

Attach a copy of your updated Curriculum Requirements checklist completed in EDUC 255, Professional Issues in Education.

Degree Audit

Attach a copy of your degree audit printed from VitNet.

Transcript

Attach a copy of your transcript printed from VitNet.

Conduct and Competency Review

Attach a copy of your Conduct and Competency Review printed from VitNet.

Remember to sign and date this form.

Attitude and Disposition Surveys

Attitude and Disposition Surveys should be distributed to two (2) Viterbo faculty members (one must be from the School of Education).

RETURN ALL COMPLETED FORMS TO: MC406