Residency Application

Placement Procedures and General Information

Return the fillable application below to Room 204 Ball Hall on or before the stated deadline date. Several fundamental requirements and expectations underline the Residency Semester. These are as follows:

1) It is the responsibility of the student to inform this office regarding any change in status, including eligibility, and to maintain a current address and phone number (please indicate if personal information is restricted). Failure to supply accurate and complete data may result in the cancellation of the application. Please note that formal communication from our office will go to the student’s University of Memphis email address.

2)Students must meet the following eligibility requirements. (These are listed in your catalog):

RESIDENCY IRESIDENCY II

●Professional Liability Insurance (valid entire placement)●Passing Score - all remaining Praxis II licensure exams

● Clear TBI Background Check●Submit Intent to Graduate Application

●Eligibility GPA of 3.0●Professional Liability Insurance (valid entire placement)

●Program Faculty Interview● No outstanding Courses (all courses passed as required) ●Exemplar Provided for Faculty Review ● Eligibility GPA of 3.0

●Successful Teacher Insight●Successful passing score on edTPA required for licensure

●No Outstanding Courses (all courses passed as required)

● Successful On-demand Writing Sample

●TEP Provisional Admittance

●Passing Score on Praxis II Content Exam (Please ensure you are registered for the correct exams for your area of licensure.

This information can be found on the ETS website under Tennessee Licensure requirements).

●Signed Application

●Degree Sheet

3)All required courses must be completed prior to Residency. Any summer courses being taken must be completed before August 1 due to the Residency start time.

RESIDENCY DOCUMENTATION

All of the following materials are required to be eligible for Residency. Note: Our office cannot make copies for students.

1)Application – typed.

2)Personal Data Sheet (6 copies).

3)PRAXIS II Scores/Registration – It is required that you take and pass all praxis II exams in your area of licensure prior to the start of Residency II. You must include either a copy of the test score or a copy of your registration for the test with the application. You must submit a copy of your passing score report for all Praxis II Exams no later than 30 days prior to starting the Residency.

Intent to Graduate – Complete the online Intent to Graduate application at the beginning of Residency II. The application can be found at

REGISTRATION PROCEDURES

Once your coursework has been reviewed,you will be contacted if you are missing anything that needs to be completed before beginning the residency. You cannot register for residency I courses until permits are issued. Once you have been approved and permits have been issued, you will be notified. You may not be notified until right before registration begins, but in some cases, it could be later.

NOTE: Residency I could start as early as the last full week in July and Residency II could start as early as January 2nd. Candidates are expected to keep the same hours as the teachers (generally a half hour before and a half hour after published school start and ending times, or as directed by your mentor teacher) and attend PTA meetings, parent conferences, etc. Notification of precise beginning and ending dates will be communicated to you.
For Office Use Only:
Residency I
___Professional Liability Insurance (valid entire placement)
___Clear TBI Background Check
___Eligibility GPA of 3.0
___Program Faculty Interview
___Exemplar Provided for Faculty Review
___Successful On-Demand Writing Sample
___ Successful Teacher Insight
___No Outstanding Courses (all courses passed as required)
___TEP Provisional Admittance
___Passing Score on Praxis II Content Exam (Tennessee)
___Signed Application
___Degree Sheet __ / Residency II*
___Professional Liability Ins (valid entire placement)
___No Outstanding Courses (all courses passed as required)
___Eligibility GPA of 3.0
___Passing Score-- all remaining Praxis II licensure exams
___Submitted Online Intent to Graduate Form
*Successful passing score on edTPA required for licensure
RESIDENCY APPLICATION
Due Date
1st Tuesday of March
Instructions:Please submit this document to 204 Ball Hall with a copy of the degree sheet you and your advisor have been following. *The degreesheet is the form you received when you began your program that includes any approved substitutions
Lambuthstudents: Please submit your application by mail (Ball Hall 204) or by fax (901-678-1523).
Name(last, first, middle): / Banner ID: U
Local Address: / City/State/Zip:
Permanent Address: / City/State/Zip:
Home Phone: Cell Phone: Alternate Phone:

University Email Address: @memphis.edu

LICENSURE PROGRAM

TALN (K-6 & SPED/Modified): ITGS: HDVL:

PETE: ART: MUSIC:

RESIDENCY CAMPUS CHOICE

The Residency coursework is offered on different campus sites. Mark your top choice. Please understand that you are not guaranteed to be placed at your top selection location:
Memphis/Shelby County: Jackson/Madison: Tipton: Dyersburg

GRADE PREFERENCE (for TALN and HDVL candidates only –preference not guaranteed)

First Choice Select onePreKK123456SPED (K-12) Second Choice Select OnePreKK123456SPED (K-12) Third Choice Select OnePreKK123456SPED (K-12)

SUBJECT PREFERENCE (for ITGS candidates only –preference not guaranteed)

First Choice Select OneSocial StudiesMathLanguage ArtsScience Second Choice Select OneSocial StudiesMathLanguage ArtsScience Third Choice Select OneSocial StudiesMathLanguage ArtsScience Fourth Choice Select OneSocial StudiesMathLanguage ArtsScience

SPECIAL CIRCUMSTANCES

Describe any special circumstances concerning your residency placement (e.g. medical problems, transportation, childcare). Attach an additional sheet if necessary(500 characters allowed in space below)

SCHOOL RELATIONSHIPS

List any schools where you have any relative(s) employed (wife, husband, child, mother, father, in-laws, sister, brother, aunt, uncle, or grandparent) or close acquaintances.
List the schools your children attend.
List any past or current school employment. Include the name of the school, your title/position and dates of employment.

RESIDENCY DISCLAIMER

Please read and sign the following statement of verification and understanding

I understand that the residency application is binding in terms of location, level, and subject requested. I acknowledge that I am responsible for my own transportation.
I understand that Residency I could start as early as the last full week in July and Residency II could start as early as January 2nd.
I understand that if I am accepted for placement, my signature below constitutes a professional agreement with a school system to complete residency I and residency II.
I agree to abide by all policies of the University of Memphis, the school district and the partnering school.
I am fully aware and understand that additional course work (except the residency seminar) is not allowed during residency II.
I understand that it is my responsibility to ascertain and meet the prerequisites outlined in the University of Memphis Bulletin prior to residency.
I understand that I must submit a copy of my passed Praxis II Content Knowledge exam at least 30 days prior to the first day of Residency I and all remaining exams 30 days prior to Residency II.
To the best of my knowledge, the information I have provided in my residency application is complete and correct.
I give my permission for the information contained in this application to become part of a residency file to be used by those professional educators responsible for arranging, monitoring, researching and evaluating my residency.
I understand a TBI Criminal Background check is required prior to residency and that the results of this check may prevent me from the residency program. At this time, I am not charged with a felony.
I understand that once all of my coursework has been reviewed I will be contacted if I am missing anything that needs to be completed before beginning my residency semester. I also understand that I cannot register for residency I courses until permits are issued. Once I have been approved and permits have been issued, I will be notified. I understand that I will not be notified until right before registration begins, but in some cases, it could be later.
I agree to accept the placement assigned to me.
Signature:______Date:______

RESIDENCY PERSONAL DATA SHEET (please type)

Name: / Email: @memphis.edu
Licensure Area: Teaching All Learners (K-6 & SPED/Modified): Early Childhood (PreK-3):
Middle Grades (4-8): PE (K-12): Art (K-12): Music (K-12):
Local Address: / Daytime Phone:
City, State, Zip: / Alternative Phone Number:

EMERGENCY CONTACT

Name: / Phone:
LIST WORK EXPERIENCES WITH CHILDREN, INCLUDING FIELD EXPERIENCE
Name of Facility / Type of Work / Dates of Service

ADDITIONAL INFORMATION

List your achievements, interests and hobbies.
List any medical conditions the Pre-Service Instructive Mentor (PIM) or University Supervisor should be aware of (information below should be listed under special circumstances in the Residency application attach additional pages if needed).
Write a short description signifying the reasons you are interested in becoming an educator. Explain why you are majoring in education, your aspirations, goals, etc., and what you hope to learn during your residency experience.

I understand that if I am accepted for placement my signature below constitutes a professional agreement with a school system to complete the residency program during the semester requested. I agree to abide by all policies of the University of Memphis, School District, and the Partnering School. I give my permission for the information contained in this personal data sheet to be shared with the Pre-Service Instructive Mentor and the University Supervisor.

Signature:______Date:______

RevisedMay 2014