University of Wisconsin – Eau Claire
College of Education and Human Sciences
Department of Education Studies
EAA/ECA Gate 1 Admission to Program Application form
(please use black or blue pen, and please print legibly)
Student Name: _______________________________________________________________________________________________________
Last Name
Check One: ______ Undergraduate
Program (check one)
First Name
____ Certification Only
Middle Initial
_____ Second Degree
_____ EAA Early Adolescent through Adolescent
_____ ECA Early Childhood through Adolescent
Eight digit Student ID number from your degree audit: _____________________________________
ES212 grade from your degree audit: ________
MUED211 grade (if applicable)
Resident GPA from your degree audit: _______
Total GPA from your degree audit:
Total credits through the end of the current semester (from your degree audit):
_______
_______
_______
CIRCLE your major on the chart below.
If you have a second major, please list it here: ____________________________________________
If you have a minor, please list it here: ____________________________________________________
Your advisor’s name: ____________________________________________________________________
EAA
ECA
English (540-210)
English Comprehensive (540-006)
Mathematics (180-207)
Art (020-072)
Science
Foreign Language
Social Studies
Music
Kinesiology (991-065)
Biology (080-205)
Chemistry (100-204)
Physics (230-205)
Earth & Space Science Comprehensive (160-015)
Physical Science Comprehensive (240-004)
Physics/Math-Physics Emphasis Comprehensive (210-003)
Physics/Math-Math Emphasis Comprehensive (210-004)
French (260-203)
German (280-204)
Latin American Studies (340-003)
Spanish (320-203)
Economics (360-204)
Geography (140-213)
History (380-206)
Political Science (420-203)
Sociology (480-204)
Social Studies-Single or Dual Concentration (please indicate area(s) of
emphasis: __________________________
Choral/General (060-058)
Instrumental/General (060-057)
Theatre Arts (601-204)
We are required to report the following data to the Department of Public Instruction.
This information is not provided to the individuals who will score your application.
I identify my gender as:
Female
I identify my race/ethnicity as:
Male
Caucasian
Asian
Trans
African American
Other
Hispanic/Latino
American Indian
Native Hawaiian/other Pacific Islander
Other
Write your LAST NAME in permanent marker on the spine on your 3-ring binder.
Place in the inside front pocket of your 3-ring binder the following:

EAA/ECA

Your unofficial UW-Eau Claire Undergraduate Transcript
 with your grade in ES212 highlighted;
 your grade in MUED211 highlighted (if applicable);
 your resident GPA and your total GPA highlighted;
 your total attempted credits through the end of the current semester
highlighted.


Appendix C – Program Completion Plan (download from website)
Gate 1 scoresheet (score of 23 required), signed by Professor
Gate 1 Admission to Program Application form (download from website)
Please do not put any of the above documents in plastic sheet protectors.