Please Include the Following Materials in This Application Packet

Central Wisconsin Alliance for Early Childhood

Program Application

School of Education

Name:
Address:
Phone Number(s):
Email:
Technical College attended/attending:
Year Associate Degree will be/was completed:
Anticipated start date: / Fall 2017 Spring 2018 Fall 2018 Spring 2019 Fall 2019

Please include the following materials in this application packet:

Reference Form completed by ECE instructor in the Technical College System. (see below)

Letter of Commitment (see form below)

Unofficial transcripts from all post-secondary schools attended (photocopies acceptable)

Course syllabi for any ECE courses completed prior to Fall 2006 (if applicable)

Return complete packet of application materials to:

School of Education Academic and Career Advising Center

CWA Program

469 College of Professional Studies

UW-Stevens Point

Stevens Point, WI 54481

Central Wisconsin Alliance for Early Childhood

Reference Form

Student’s Name:
ECE Instructor’s Name:

Student Release Statement

I authorize the ECE instructor listed above to release, including discussion of, any and all educationrecords to or with UW-Stevens Point for the purpose of providing a recommendation for the Central Wisconsin Alliance Program.

Further, I hereby release ______(WTCS school), its employees, officers or agents, both individually and collectively, from any and all liability for damage of whatever kind, which may at any time result to me, my heirs, family and associates because of compliance with this authorization and consent to release information, or any attempt to comply with it.

______

Student SignatureDate

Note to instructor: This student is applying to a cohort-based Early Childhood Education Program through UW-Stevens Point. As part of the application process, the student is required to obtain a reference from an ECE instructor at the WTCS campus they attended.

Superior / Above Average / Average / Below Average / Not Observed
Use of technology
Organization
Quality of work
Verbal Communication
Written Communication
Initiative
Ability to work alone
Ability to work with others
Leadership skills
Dependability
Professionalism
Academic ability to pursue a Bachelor’s degree

Additional comments:

Instructor’s signature: ______Date: ______

This form was provided to the student in a sealed envelope? ___ YES ___ No If yes, please inform the student that the envelope should remain sealed. This is at the discretion of the instructor.

Please return the completed form to the student.

This form must be included in the student’s application packet.

Central Wisconsin Alliance for Early Childhood

Letter of Commitment

Name:

Please provide us with brief comments on each of the following topics. Please feel free to attach additional pages if necessary.

Please describe your interest in the Central Wisconsin Alliance for Early Childhood Education Program.

What challenges do you foresee, if any, in completing this program?

Additional Comments:

Do you plan on working while attending school? YES NO

If Yes:

a.Approximately how many hours per week? ______

b.Does the job entail working with children? YES NO

c.Do you know the hours each day you will work? (Example: 7-3 Monday through Friday)

Please rate your level of comfort for the following technology applications:

Very Comfortable / Comfortable / Not Comfortable
Email
Word processing
Internet
Online assignments
Online discussions
ITV courses

I have read the Program Description, Expectations, and Course Timeline and I am committed to successfully completing the Central Wisconsin Alliance for Early Childhood Education Program:

Signature: ______Date: ______