Graduate Education Programs

SECOND STAGE REVIEW: Form T-16

NON-LICENSURE/PROFESSIONAL PROGRAMS

FORMAL ADMISSION TO ADVANCEDFIELD-BASED PRACTICUM

Revised 11/14/2018

Name: ______Banner I.D.: ______

Street: ______Town: ______Zip Code______

Telephone Number: ______E-mail Address: ______

Revised 11/14/2018

Educator Licensure Program:______

Instructions:

Step 1: Review candidate records and respond to questions below regarding requirements.

Step 2: Make recommendations.

Step 3: Invite candidate response.

Step 4: Make a copy of this form for the candidate’s advising folder.

Step 5: Forward the original review form along withCandidate Dispositions Assessment(s) and other supporting documents to the Licensure Office within one week of the advising period.

For the items below, please provide the appropriate answer. If “No” or “N/A,” please note the next action step under “Comments.”

REQUIREMENTS / Yes / No / N/A / Comments
1. Have all Candidate Dispositions Assessment Forms been reviewed?
2. Has the candidate completed all professional coursework required in the program prior to field based requirement?
3. Has the candidate successfully completed all field-based experiences related to coursework?
4. Has the candidate presented evidence of Educator as Reflective Leader?

Page 2: Graduate Second Stage Review

Advisor’s recommendations (check all that apply):

Retain in major and recommend for field based experiences

Retain in major, not eligible for field based experiences

(specify reason): ______

Needs a departmental review (specify reason): ______

Change track within major to ______

Withdraw from a class (provide course number and title):______

Take specific courses (provide course number and title): ______

Other (specify): ______

Candidate’s decision (check all that apply):

Continue in major

Change track within major to ______

Withdraw from a class (provide course number and title): ______

Take specific courses (provide course number and title): ______

Other (Specify): ______

I, ______, (Candidate’s printed name)

certify that I have reviewed this form with my advisor. I understand that I must satisfy all of the requirements outlined on this form to be approved for admission to the take the appropriate content subtest(s) of the Massachusetts Tests for Educator Licensure. By signing this statement, I am indicating my wish to make a formal application to the field based requirement in:

______.

(Major)

______

(Candidate’s Signature)(Date)

______

(Advisor’s Signature)(Date)

*************************************************************************************************************************************

Is the candidate approved for formal admission to the field based experience by the Office of the Dean of Education?

_____Yes.

_____ No. If no, please state a reason for non-approval: ______

Approved by:

______

(Printed name of the Dean of Education/Director of Licensure)

______

(Signature of the Dean of Education/Director of Licensure) (Date Approved)

Revised 11/14/2018