Please type all information. Click in the fields, or use your TAB key to navigate the document.
PRAIRIE
E VIEW A&M
A
UN
NIVERSIITY
A Member of Th
he Texas A&M University Sysstem
Departmentt of Curricu
ulum and Instruction
Tea
acher Candidate Applic
cation for Approval
A
to Register for TExES® E
Examination
n
D
Date________
___________
_________
T
Teacher Cand
didate ______
___________
____________
___________
___________
___________
____________
________
Last Name
Fiirst Name
P
PVAMU ID#__
___________
______
TEA ID#______
____________
____
G
Gender Select from the list below.
MI
Date o
of Birth _____
__/______/___
________
Ethn
nicity Select from the list below.
H
Home Phone_
___________
___________
_____ Cell Phone________
___________
______
Cell
Besst Contact #__
________
E
E-mail______
____________
___________
___________
___________
____________
___________
___________
_________
A
Are you currently an Underrgraduate student? Yes
If, "Yes", lisst your expectted graduatio
on date______
________
M
Major _______
___________
___________
____________
___________
___________
___________
____________
________
C
Certification Area________
A
___________
___________
____________
___________
___________
___________
_________
A
Are you enrollled in the ATC
CP? No
If, "Yes", lis
st your certificcation area__
___________
____________
________
A
Are you a form
mer PVAMU Teacher
T
Cand
didate gradua
ate? No
If, "Yes", list tthe graduatio
on date______
________
D
Date accepted
d into Teache
er Education or
o the ATCP_
____________
____________
___________
___________
_________
C
Choose the te
est for which you
y are registtering. Select from the list below.
Iff you choose "OTHER", please indicate
e the test ____
___________
___________
___________
____________
________
It is you
ur responsib
bility to check with your advisor
a
and//or the TExES
S® Assessme
ent Coordina
ator
number!
to make surre you selectt the correct test & test n
A
Advisor_____
____________
___________
___________
____________
____________
___________
___________
_________
T
Teacher Cand
didate Signatu
ure________
____________
___________
___________
______ Date
e___________
________
- - - - - - - - - TExES® ASSESSMENT
A
T COORDINA
ATOR APPR
ROVAL - - - - - - - - R
Representativ
ve Test Score
e___________
__
Certifyy Teacher Tesst Score_____
________
D
Documented Review Hours
s__________
___
Clear B
Background C
Check______
___Yes
___
______No
C
Comments___
___________
___________
____________
___________
___________
___________
____________
_________
_
___________
____________
___________
___________
____________
____________
___________
___________
_________
T
TExES® Assessment Coord
dinator Signa
ature________
___________
___________
_________ Da
ate_________
________
- - - - - - - - - ADVISOR
R AND DEPAR
RTMENTAL H
HEAD APPR
ROVAL - - - - - - - - A
Advisor Signa
ature_______
____________
___________
___________
____________
_______ Date
e___________
________
D
Department Head
H
Signaturre__________
___________
___________
___________
________Date
e__________
_________
- - - - - - - - - FOR
R CERTIFICATION OFFIC E USE ONLY
Y - - - - - - - - D
Date Received__________
___________
___________
___
E
Eligibility Apprroval Code:
F
Finisher_______
st
1 Time Taker___
_____
Eligible (0)_____
___
Approved (1)_______
Ap
pproved Until Re
emoved (3)_____
___
Clinicall_______
nrolled_______
Other En
Repeatt in Window____
____
Repeat, Out
O of Window__
______
EXAM ONLY__
_______
Denied (4))_______
Non-C
Completer______
___
D
Date Entered_
___________
________ Enttered by_____
___________
___________
___________
____________
________
®
Whitlowe R. Green Colle
ege of Educatio
on
P.O
O. Box 519; MS
S 2400 Prairie View, TX 7744
46
(936) 26
61-3403 Fax (936) 261-362
21
T
Teacher Candida
ate Application fo
or Approval to Re
egister for TExES
S Examination
9
9/22/2015
PRINT
SAVE