Central Wisconsin Alliance for Early Childhood
Program Application
School of Education
Deadlines: We are currently accepting applications for the next cohort of students – Cohort III. Once we receive
enough applications from students, we will start Cohort III. You may be able to start the remaining general education
courses prior to the start of the next cohort.
Name:
Address:
Phone Number(s):
Email:
Technical College
attended/attending:
Year Associate Degree
will be/was completed:
Anticipated start date:
Fall 2015
Spring 2016
Fall 2016
Spring 2017
Fall 2017
Please include the following materials in this application packet:
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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:
SOE Advising, Recruitment & Retention Office
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 education records 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 Signature
________________________________
Date
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:
Email
Word processing
Internet
Online assignments
Online discussions
ITV courses
Very Comfortable
Comfortable
Not Comfortable
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: _______________________