The Institute of Professional Educator Development

The Institute of Professional Educator Development

Telephone: (262)595-2180

Fax: (262)595-2265

APPLICATION FOR ADMISSION TO

THE EDUCATOR PREPARATION PROGRAM9.28.2015

Last Name: / First Name: / Middle Initial: / Student ID Number:
Student SS#:
Current Mailing Address including City, State and Zip Code: / Phone Number: / Ranger email:
Licensure Level:
Choose an item. / Certifiable Major:
Choose an item. / Minor (if applicable): / Degree Seeking Status:
Choose an item.
Primary Language: / Other Language: / Other Language: / Date of Birth (MM/DD/YYYY):

Candidates for all programs leading to educator licensure must satisfy the qualifications for admission to the Educator Preparation Program. Late or incomplete applications will not be accepted, you will need to wait for the next admission date.

Candidates meeting the minimum qualifications for entry are not guaranteed acceptance. A formal review of applicant’s knowledge, skills and disposition will be reviewed by the Educator Preparation faculty and staff, at which time an admission decision will be made. The qualifications for entry are subject to change, and the most up-to-date qualifications will be reflected on the Institute of Professional Educator Development website. Applications will be accepted from candidates who are in-process of completing qualifications during the semester of application, however, acceptance will not be granted until all qualifications are met and documented by the IPED Director of Certification. In-process candidate qualifications will be reviewed up to the start of the semester the candidate wishes to enter the Educator Preparation Program. If completion of the qualifications cannot be verified prior to the start of the semester, candidates may be delayed.

Provide the required information for each of the qualifications and hard copy evidence if required. A copy of your DARS is required.
Requirements / Qualification Met
(provide required info here or check mark for completion) / For IPED Use Only
Admission to the University of Wisconsin-Parkside (date)
Completed a Plan Declaration for the Educator Development Program
(You must have done this at least 3 weeks prior to the application for this requirement to show in SOLAR)
Completed a Plan Declaration for your intended “licensable” major; or planned and intended pathway to explore a licensable major as shown with your IDP
(You must have done this at least 3 weeks prior to the application for this requirement to show in SOLAR)
Cumulative GPA at application
Insert a letter grade for the following required courses: ENGL 101: MATH 111:
Communication Skills Assessment
Please check the box for the communication skill assessment you are using for this application and fill in your appropriate scores.
Praxis CORE Reading Writing Math
Praxis I Reading Writing Math
ACT Composite Reading English Math
SAT Composite Math Verbal
GRE General Revised TestComposite Verbal Math
Following admission to the Educator Preparation Program, students must maintain a 3.0 GPA, with no single course grade lower than a C+ in all required Educator Development Program coursework, with the exception of Residency which requires a grade of B or better. (This does not include the major.)
Student Signature: / Date:

To be completed by Director of Certification Only:

Application Complete:
Yes or No / Background Check Rec’d:
Yes or No
Admission Decision:
Admitted Denied Date
Notes: / Director of CertificationSignature:

Return completed form, copy of your DARS, and all attachments to The Institute of Professional Educator Development, MOLN D-111 or by email to. Application Rec’d:

Date Time