Application to Enroll in Internet Mat Courses

APPLICATION TO ENROLL IN INTERNET MAT COURSES

Directions: The purpose of this form is to establish student eligibility to enroll in 100% Internet MAT courses. To be eligible, employment must be full time as the teacher of record in the grade level and area of certification pursued. Please fax this form and required documents to the Master of Arts in Teaching Program 985-549-5239, Attention: Dr. Paul Goodwin. If you have transmission difficulties, please call 985-549-5736.

***TO BE COMPLETED BY THE STUDENT***

Directions: Please complete the form below to verify employment in the area and grade level of the certification pursued at SoutheasternLouisianaUniversity.

Name______SLU ID#______

Home Address______City/State/Zip______

Phone Numbers (Home and Cell)______

School______

School Address______City/State/Zip______

School Phone Number______

Certification Area______

If Secondary, Specialty Area______

I. Verification of Employment: Attach a copy of your contract/employment agreement

for the 2005-2006 school year. The verification can be:

(1)A copy of your 2005-2006 contract with appropriate signatures;

(2)A copy of the school board minutes approving your employment;

(3)A letter from your Human Resources Administrator on office letterhead

II. Teaching Schedule: Attach a copy of your teaching schedule for 2005-2006 clearly

stating the subject, grade level, and number of students in each class. Students in the

Elementary/Special Ed. program must indicate the number of regular and

mild/moderate students in each class. The teaching schedule must be signed by the

principal. Note: A new signed teaching schedule must be submitted each semester

for approval to enroll in internet courses.

III. MAT Course Information: Indicate below the courses you plan to take this

semester. Indicate the year by the semester.

Summer______Fall______Spring_____

MAT Course Numbers (List Below)

______

***TO BE COMPLETED BY THE SCHOOL PRINCIPAL***

Directions: Please provide the information requested below:

This is to verify that the MAT student______

is a full time teacher of record at ______School

during the ______academic year.

______

Principal’s Name (Type or Print) Principal’s Signature

School is State Approved(Required) ___Yes ___No

Regionally Accredited (Required for Secondary) ___Yes ___No

School Classification ____Public ___Private

Evidence of Cultural Diversity

(1)Attach a copy of the school profile or

(2)A statement demonstrating evidence of open enrollment

Attach the Following Documents

(1)Copy of the Principal or Assistant Principal or Designated Supervisor’s Certificate (Must be certified in principalship)

(2)Verification of Years of Employment of Principal or Assistant Principal or Designated Supervisor (Minimum of three (3) years in role is required)

(3)Copy of Mentor Teacher’s Certificate

(4) Verification of Years of Employment of Mentor Teacher (Minimum of three (3) years preferably in the area of the student’s certification)

(5)Copy of Regional Accreditation Certificate (Required for secondary placements)

______

Notes:

Students enrolled in the Elementary and Special Education (Mild/Moderate) MAT program after the Fall Semester 2004 must teach in an Inclusive classroom (grades 1 to 5). The classroom must have a minimum of sixteen (16) students with a minimum of three (3) students with active IEPs.

Students enrolled in the Secondary MAT program must be teaching a majority of the time in the area of certification. They must teach a minimum of 12 students per class average.