PR AI RI E V IE W A & M U NI VE RSI TY
Wh i tl ow e R . G re en C o l l eg e o f Ed u c at i on / D ep ar t me n t o f C u r r icu l u m a nd I ns t ru c t i on
TEACHER CANDIDATE APPLICATION FOR APPROVAL TO REGISTER FOR TEXES® / EXCET® EXAMINATIONS
PLEASE PRINT LEGIBLY!
Date of Application _________________________ Received By ___________________________________________ Title _________________________
TEACHER CANDIDATE ____________________________________________________________________________________________________________
Last Name
First
MI
Student ID # ____________________________
TEA ID# _______________________________
Date of Birth ___________________________
Gender
Ethnicity / Race (Check one) ___ African American
___ White ___ Hispanic ___ Other
___Male ___Female
CONTACT INFORMATION
Home Phone # ____________________________
Cell Phone # ________________________
Best Contact # ____Home ____Cell
PVAMU Email Address: _________________________________________________________________________________________________
CANDIDATE STATUS
Are You an Undergraduate Student? ____Yes ____No
If “YES”, What is Your Expected Graduation Date? _______________________
Date Accepted Into Teacher Education ___________________________
Major ___________________________________________________
Are You a Current PVAMU Graduate Student
Certification Area ___________________________________________
___Yes ___No
If “YES”, What is Your Expected Graduation Date? ____________________
Are You Enrolled in the ATCP Program? ___Yes ___No
Highest Degree Completed _________________
If “Yes”, What is Your Certification Area? ________________________________
PVAMU Graduate? ____Yes ____No
Date Graduated _____________________
PPR EC-12
(160)
Mathematics 4-8
(115)
PPR/Trades & Ind. Ed. 8-12
(170)
Mathematics 8-12
(135)
Generalist EC-6
(191)
Science 4-8
(116)
Generalist 4-8
(111)
Science 8-12
(136)
NOTE: It is YOUR RESPONSIBILITY to
Special Ed. EC-12
(161)
Life Science 8-12
(138)
check with your advisor and/or the
TExES Assessment Coordinator to
make sure you select the correct test
& test number!
ELA/Reading 4-8
(117)
Social Studies 4-8
(118)
ELA & Reading 8-12
(131)
Social Studies 8-12
(132)
Health EC-12
Physical Ed. EC-12
(157)
(133)
(158)
History 8-12
Reading Specialist
Other__________________
(_____)
LOTE Spanish
(613)
TEST CHOICE: Place a check
mark ( √ ) to the LEFT of the Test
Name and Number that you wish
to attempt. YOU CAN ONLY APPLY
FOR ONE TEST AT A TIME.
ADVISOR: ____________________
(Print Name)
_______________________________________________________
Teacher Candidate’s Signature
(151)
_______________________________
Date
TExES® ASSESSMENT COORDINATOR APPROVAL
Documented Review Hours: _______
Documented Representative Test Score: _________
_________________________________________________
Signature of TExES Assessment Coordinator
Clear Background Check ___Yes ___ No
____________________________ Comments: _____________________
_______________________________
Date
ADVISOR AND DEPARTMENTAL HEAD APPROVAL
_______________________________________ ______________
Advisor’s Signature
Date
_______________________________________ _______________
Department Head’s Signature
Date
FOR CERTIFICATION OFFICE USE ONLY
Eligibility Approval Code: Eligible (0) _____
Approved (1) ____
Approved Until Removed (3) _____
Denied (4) _____
___Finisher ___Clinical ___Other Enrolled ___ EXAM ONLY ___Non-Completer ___1st Time Taker ___Repeat in Window ___Repeat, Out of Window
Date Entered: ___________________________________
Revised 08/28/2011 DBG
Entered By: ______________________________________________________________