California State University, Los Angeles
Charter College of Education, Division of Special Education & Counseling
OSEP Grant Application: Preparing Future Educators of the Blind and Visually Impaired to Use
and Teach Technology
EDUCATIONAL SPECIALIST CREDENTIAL IN VISUAL IMPAIRMENT & BLINDNESS
Name: _______________________________________________ Date: ___________________
Address: _____________________________________________ CIN#:___________________
______________________________________________________________________
Phone: (Day) _____________________________ (Evening)_____________________________
E-mail: _______________________________________________________________________
Ethnicity (circle one, optional):
African-American
Hispanic-Non-white
Euro-American
Asian-Pacific Islander
Other (please specify): _____________________________________________________
Education Background:
B.A./B.S.: Major: ______________________________________GPA:____________________
Institution: __________________________________ Date of Graduation: ________
M.A./M.S.:
Major: ___________________________________GPA: ___________________
Institution: ________________________________Date of Graduation: ________
Credential/Certificates: __________________________________ Date Issued: ______________
Institution: ________________________________Date of Expiration: _________
Credential/Certificates: __________________________________ Date Issued: ______________
Institution: ________________________________Date of Expiration: _________
List other course work/training related to special education or visual impairment and blindness, not taken
at CSULA:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Work Experience:
(List most recent experience first) Please attach additional pages if necessary.
Dates From/To Position
Supervisor
Employer/Agency
Hour Per Week
Phone
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Have you passed the CBEST? (Circle one)
Yes
No
Have you passed the CSET? (Circle one)
Yes
No
N/A
N/A
Date: _____________
Date: _____________
* Include verification of passing scores on all exams
Are you currently enrolled at CSULA
Yes
No
CSULA GPA: ____________
Have you applied to the Charter College of Education (CCOE)
*Identify your CCOE admissions status (circle one)
Yes
pending
No
conditional
formal
*Include a current transcript of CSULA courses
*Note: Formal admissions to CCOE and VI Program are required for funding under this grant.
Can you make a 2 year commitment to complete the Education Specialist Credential in VI (circle
one)? Yes
No
Would you be willing to share information about your teaching performance with other students in the VI
program (e.g. video tapes of your teaching, lesson plans related to technology, performance data – circle
one)? Yes
No
Have you taken classes in the CCOE?
Yes
No
* If so, include a CSULA transcript with your application
SHORT RESPONSE QUESTIONS (Please attach additional word-processed pages):
Please explain why you are interested in participating in this grant Preparing Future Educators of the
Blind and Visually Impaired to Use and Teach Technology program and in the CSULA VI Credential
program (in 200-500 words).
Please explain why you feel you would be a good candidate for this technology related traineeship in
particular (in 200-500 words).
Describe what your philosophy is regarding the use of a variety of technology in educational settings (e.g.
instructional technology, assistive technology, informational technology, and educational technology) and
how you view technology in relationship to accessing the general education curriculum. (in 200-500
words)?
Include with your application:
1.
Verification of passing CBEST scores
2.
Verification of passing CSET scores
3.
Current CSULA transcripts
4.
Transcripts from other universities
5.
Any valid teaching credentials
6.
Formal letter of admissions
Submit Application to:
Dr. Cheryl Kamei-Hannan
California State University, Los Angeles
Charter College of Education
Division of Special Education & Counseling
5151 State University Drive
Los Angeles, CA 90032-8144