ACCEPTANCE TO THE TEACHER EDUCATION PROGRAM
Last Name
First Name
Birthday (xx/xx/xx)
Initial
SSN (xxx-xx-xxxx)
Requirements for Acceptance into the Teacher Education Program
1. A minimum of 2.50 cumulative G.P.A.
2. A total minimum of 2.50 GPA in University Seminar, College Writing and Quantitative Reasoning (Core) with no
grade lower than a ‘C’ (a grade of ‘C-’ or lower is not acceptable).
3. A record free of, “conviction of, entry of a guilty verdict, a plea of guilty, or a plea of no contest to a criminal offense
involving moral turpitude in this state or any other state or country,” (Montana Annotated Code, Sec. 20-4-110).
In order to meet the requirement for question #3 (above), you need to answer the following questions:
a.
Have you ever been convicted of a crime more serious than a minor traffic violation? This disclosure must
be made irrespective of whether the record was sealed or expunged, you served a sentence and had your civil
rights restored, the sentence was deferred or suspended, or the charge was dismissed after conviction.
Yes
No
If your answer to the above question is a “Yes”, explain fully below, specifying the nature of the offense(s),
the date(s) it/them occurred, the name and location of the court (s), and the sentence(s) imposed. This
disclosure must be made irrespective of whether you served a sentence and had your civil rights restored.
Use additional pages if necessary.
b. Are you currently on probation, deferred prosecution, suspended sentence?
Yes
No
If your answer to the above question is “Yes”, explain the circumstances and include the restrictions imposed
by the courts. Use additional pages if necessary.
Schools will require a criminal records check before placement in public schools. MSU will receive your complete criminal
record before placing students.
I hereby certify that the above information is true and correct, and I understand that any misrepresentations on this
application may be grounds for denial of the application. By signing below, I acknowledge that all the information is accurate,
and I give the Montana State University Education Department permission to verify any information provided.
____________________________________________________
Signature
_______________________________________
Date
Catalog: 2004-2006
Social Studies Broadfield
Montana State University
Secondary Teacher Education Preparation Program
ID:
Name:
Social Security #
Date:
Last Name
First Name
Initial
Local Address:
m/d/yr
Phone:
Street
City
State
Zip
Degree:
College Degree Completed
College Degree Sought
Academic Courses
Subject
#
GEOG
GEOG
105D
201D
World Regional Geography
Human Geography
HIST
HIST
HIST
HIST
HIST
NAS
POLS
POLS
104D
105IH
107IH
155IH
156IH
201D
206IS
241D
World History
West Civ to 1600
Western Civ: 1600-Present
America & World Before 1865
America & World After 1865
American Indians in Montana
Government of the U.S.
Intro to International Relations
ECON 101IS
ECON 102
Substitution Courses
Course Title
CR
Econ Way of Think
Macro & Internt’l Econ
SOC
POLS
PSY
HIST
HIST
HIST
402
404
447
Trans-Mississippi West
Montana and the West
Hist of the No American Indian
304
350
420
441
The U.S. Presidency
Natural Resource Policy
Native Amer Gov’t & Politics
International Human Rights
HIST
Grade
Subject
#
Take one of the following:
3
3
Take all of the following:
4
4
4
4
4
3
3
3
Take 1 of the following:
3
3
Required electives:
3
3
3
Take 1 of the following:
3
3
3
History elective (300-400)
3
POLS electives (300-400) 6 credits:
Recommended courses:
POLS
POLS
POLS
POLS
ECON
ECON
ECON
GEOG
GEOG
GEOG
SOC
SOC
SOC
PSY
PSY
PSY
3
3
3
3
Take 9 credits in 1 of the following areas:
Course Title
CR
Grade
Academic Courses
Subject
#
Course Title
Take One of the Following:
HDCF
150IS
Lifespan Human Develop
3
HDCF
160
Hum Dev: Conception to Adol
3
Secondary Professional Preparation
EDCI
102
In-School Experience
1
EDCI
209
Ed Psychology & Adol Dev
3
EDCI
223
Basic Media Production
1
EDCI
320
Found of Instr Computing
2
EDCI
360
Foundations of Assessment
2
HDHL
106
Drug/Health Issues for Educ
1
EDSD
363
Multicultural Education
1
EDSD
458
Methods of Teach Soc Studies
3
HDCF
356
Substitution Courses
CR
Grade
Subject
#
Course Title
CR
Grade
Exceptional Needs (0-21)
3
EDSD
301
Paraprofessional Experience
1
EDSD
410
Student Teaching (10-12 CR)
EDSD
413C
Professional Issues
2
MATH
ENGL
121W
College
Writing I
3
COM*
110US
Intro to
Public
Commu
nication
3
*May take approved courses with the letters US for
University Seminar Core.
For Office Use Only:
First Aid with CPR
Paraprofessional Experience
Disclosure Statement
_____________________________________________________________________________
Student's Signature
________________________________
Date
_____________________________________________________________________________
Advisor’s Signature
________________________________
Date
_____________________________________________________________________
____________________________
Certification Officer's Signature
Date
For Use When Completing Student Teaching Application:
* Taking this course Spring Semester
** Taking this course Fall Semester or Summer Semester