Application for
Professional Admissions and Student Teaching
INSTRUCTIONS
Complete and submit three (3), individually stapled, typed and signed copies by the date listed in the course syllabus.
It is very important that the application look as professional as possible as these copies will be sent to and reviewed by the various school personnel under whom you will be doing your student teaching.
To access the appropriate elementary or secondary application form, go to:
Department of Education SECONDARY
College of Arts, Letters and Education
312 Williamson HallToday’s Date: ______
Cheney, WA 99004-2458 EWU ID: ______
APPLICATION FOR PROFESSIONAL ADMISSIONS
AND STUDENT TEACHING
Personal Information / Planned quarter forstudent teaching:
Fall Year:
Winter ______
Spring
FULL NAME:
Last First Middle
Maiden/Former Name / EMAIL ADDRESS:
PRESENT ADDRESS:
Street City State Zip Phone
PERMANENT ADDRES:
Street City State Zip Phone
HIGH SCHOOL GRADUATE OF:
School Name State County / STUDENT TEACHING PLACEMENT:
Do you have children in the Student Teaching Placement School?
No Yes, in grade(s):
RELATIVES EMPLOYED IN THE EDUCATION SYSTEM: I have no relatives that currently work in the education system
Relative Name State County School/Location Position
EWU DEPARTMENT OF EDUCATION PLAN
List Major (s) List Minor (s) Preferred level for student teaching internship:
Any Middle School/Jr. High Senior High
School Placement Information By Course
EDUC 413 / EDUC 341 / EDUC 420
Name of School Placed In
Quarter and Year
Grade and/or Subject
Teacher (s)
Higher Education History (most recent first)
Name of College/University State Year(s) Attended Degree (if any)
General Education Requirement and Prerequisite Information
Requirement / Course Title / Grade / Credits / Completed
Quarter Year
ENGL 101 / College Composition: Exposition and Argumentation
ENGL 201 / College Composition: Analysis, Research and Documentation
MATH 115 / Mathematical Reasoning
CMST 200 / Introduction to Speech
Last Modified: 10/22/2013 Application for Professional Admissions and Student Teaching Department of Education
Forms/420SecAdmission SECONDARY Eastern Washington University
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[Type text]
Department of Education Course Information (note anticipated quarter and year if not taken or in progress)Requirement / Course Title / Grade / Credits / Completed
Quarter Year
EDUC 200 / Admission to the Teacher Education Program
EDUC 201 / Introduction to Education
EDUC 303 / Foundations of Assessment
EDUC 341 / Secondary Strategies, Management and Assessment
EDUC 413 / Content Area Reading, Management and Assessment
EDUC 309 / Foundations of Secondary Classroom Management (was EDUC 419)
EDUC 420 / Admission to Professional Candidacy
CEDP 302 / Educational Psychology
CEDP 363 / Introduction to Special Education
Cultural/Diversity Program Course Requirement
Course # / Course Title / Grade / Credits / Completed
Quarter Year
West B Pass Date: Fingerprint/FBI Clearance Expiration Date:
Requirement / Course Title / Grade / Credits / Completed
Quarter Year
Last Modified: 10/22/2013 Application for Professional Admissions and Student Teaching Department of Education
Forms/420SecAdmission SECONDARY Eastern Washington University
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List all Courses Required to Complete Minor (s) and/or Dual Major:Requirement / Course Title / Grade / Credits / Completed
Quarter Year
Additional Information
Other work/volunteer experience with children/young people:
Extra-curricular activities willing to direct or assist:
Travel/other work experiences:
Awards/Accomplishments:
Brief (1 – 2 paragraph) philosophy of education statement:
Date and Signature
I certify that the above information is correct, that I have completed at least two-thirds (2/3)of the total requirements
in my major, and that I have a cumulative grade point average of at least 2.5 with no grade below a 2.0.
______
Signature Date
Last Modified: 10/22/2013 Application for Professional Admissions and Student Teaching Department of Education
Forms/420SecAdmission SECONDARY Eastern Washington University
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