Department of Educational & Clinical Studies University of Nevada, Las Vegas

College of Education

q Spring q Fall

FOR OFFICE USE ONLY
Date Received / Return the completed application to your advisor, no later than April 1 for Fall and no later than October 1 for Spring placements.

APPLICATION FOR ESP-781

GRADUATE Field Experience in Early Childhood Special Education

Date of Application

Applicant’s Full Name NSHE#

Applicant’s Complete Address Zip

Home Phone Work Phone Email

Semester in which applicant requests student teaching

Are you seeking initial licensure in the state of Nevada? ______

Applicant’s PPST Scores (required for initial licensure) : R _____M______W __ Date Taken ______

Required passing scores: R=174 W=172 M=172

Applicant’s PRAXIS II Education of Young Children 0021 _____ EC Content Knowledge 0022 _____ Date Taken______

Revised 9/15/08

Licensure requirements met: Yes [ ] No [ ] ______Advisor’s Initials

Total hours of credit earned at UNLV by the end of

the current semester (Do not include any credits

transferred from other colleges or universities). ______

Revised

Courses in which applicant is currently enrolled:

Dept. / No. / Course Title / Credits

PREFERENCES:

Please check your grade level preference for student teaching.

Elementary Level

q 1st Grade q 2nd Grade

PLACEMENT PREFERENCE:

Indicate your preference for a school placement (this is not a guarantee):

q East of Las Vegas Blvd q West of Las Vegas Blvd

Do you have special circumstances that should be considered in selecting your school placement? Be specific.

Revised

LICENSURE REQUIREMENTS
COURSE / CREDIT / GRADE
ESP-771 or ESP-471 / 3
ESP-772 / 3
ESP-773 / 3
ESP774 or ESP 776 / 3
ESP-775 or ESP776 / 3
ESP-779 / 3
ESP-781 / 3
ESP-781 / 6

NEVADA SCHOOL LAW

COURSE / CREDIT / GRADE
EDA 200 / 2
(May test out)

Overall GPA (Refer to most recent grade report) ______

Total credits earned prior to student teaching ______

(Include courses currently enrolled)

I have prepared this document and all information contained herein is true.

Student Signature: ______Date______

Faculty Advisor: ______Date ______

Revised