Peer Review Project
ForEarly Childhood Educator Licensure
Due January 10, 2015
APPL I C A T I O N
NOTE: This is a fillable form. You can type in the gray boxes as much information as needed. It may adjust the page layout if you extend into an additional line. You can save this document and email it with the other required documents to oucan also print and mail any documents (see address below).
Name / DateHome Address
County / BFIS Q and C # (if known)
Home Telephone / Work Telephone
E-mail / Cell Phone
Relevant Work Experience: To apply for this project you must have at least 3 years of experience working with young children. Pleaselist all experiences working with young childrenstarting withthe most recent.
PositionEmployer and TownDates of employment
Educational Background: To qualify for this project you must have a Bachelor Degree or a Graduate Degree. Please list your college education experiences starting with the most recent.
College attended Major Degree earnedDates attended
Licensure Status
- Do you have a current Vermont educator license? YES NO
- If yes, Level Endorsement area Renewal date
- Have you ever held an educator license from Vermont or another state? YES NO
- If yes, which state?Endorsement area Date expired
- Have you passed the Praxis Core (Vermont’s educator testing requirement)? YES NO
- Have you completed a student teaching experience? YES NO If yes,grade level
- Have you worked with young children with guidance from a supervising or mentor teacher/director?
YES NO
- Have you ever been recommended for licensure from an institution of higher education?
YES NO
9. Do you have regular access to the technology needed (computer, internet, and e-mail) to complete the online component of this course? YES NO
10. Have you previously participated in Transcript Review? YES NO
11. Have you previously participated in Peer Review? YES NO
12. Have you participated in a Peer Review workshop offered by the Vermont Department of Education?
YES NO
13. Do you have a Northern Lights early childhood level certificate? YES NO DON’T KNOW
If YES, which level?(I, II, III, IV, V)
14. Why are you interested in obtaining licensure at this time?
15. Please label and send the following additional documents (a-f):
a) Short essay: The Peer Review process requires strong writing and organizational skills, an ability to manage time and a capacity to work independently. Please describe a professional achievement or challenge that you believe demonstrates your ability to successfully complete the peer review process.(Should be approximately 500 words)
b) Copy of all college transcripts (copies are accepted for this application)
c) List your professional development activities not listed in your transcriptsuch as workshops, conferences, in-services. An approximate list is fine—you will develop a more exact list when you begin working on your portfolio.
d) References: List contact information (name, e-mail, phone number and professional affiliation) from 2 professionalsthat can address your ability to successfully complete this project.
e) Attach a current resume
Please send all documents either by email to or by mail to:
Sherry Carlson; Northern Lights - 380 Round Barn Road; Ferrisburgh,Vermont, 05456
If you send some by email and others by mail, please indicate this clearly.
16. I have read the Peer Review Project Handbook YES
Questions? Please contact Sherry Carlson at (preferred)or
Nancy Sugarman at Northern Lights(802)-828-2876 or
PRP Application 20151