Application to Professional Semester

Graduate (MAT) Application

COLLEGE OF EDUCATION TEACHER CANDIDACY

Concordia University Chicago

H# ______Name ______

(Print Name)

Address ______City/State/Zip ______

Cell Phone ______Home Phone ______

Concordia Email Address ______

Public Teacher Education Program of study ______

Requirements to be met:

Cumulative GPA of 3.0 or higher at Concordia

Required prerequisite courses completed with a grade of C or better

Testing Options: (Check one)

□ Illinois Test of Academic Proficiency (TAP) –Proof of passage or Test Registration must be handed in

with application

□ ACT with Writing Section score of 22 or higher (no more than ten years old) – See instructions below

□ SAT score of 1030 or higher – score includes mathematics and critical reading only - (no more

than ten years old). – See instructions below

·  If you have not already submitted an official score report to Concordia University Chicago, you must request that ACT or SAT send an official score report to Concordia University Chicago.

·  If score was reported before October 2012, score must be reported again to reflect written section.

·  If the required score is not on file with Concordia University Chicago, please include with your application proof you have requested the scores be sent to Concordia University Chicago and a copy of your scores from ACT/SAT.

·  If you are taking the ACT/SAT, please include with your application proof you have registered to take the ACT/SAT

Updated Program Plan from MAT Advisor

Fingerprint Criminal Background Check Results

20 pre-professional field experience hours on file in the College of Education

Complete Dispositional Assessment of CUC Conceptual Framework for yourself.

Form will be sent to you electronically after you submit this Application.

I hereby verify that I have reviewed and approved this application. I understand that I am responsible for all the requirements listed on this application.

Candidate Signature: ______Date: ______

I hereby verify that I have reviewed and approved this application.

MAT Advisor Signature: ______Date: ______

Print Advisor Name: ______

Candidates do not write below solid line.

Please indicate the department, coordinator or MAT Advisor’s action and return to the Office of Field Experience.

Action:
Approved / Conditional / Denied

Comments:

Dept. Chair/Coordinator’s Signature: ______Date:______

Revised 01/2014