ACCEPTANCE TO THE TEACHER EDUCATION PROGRAM Last Name First Name Birthday (xx/xx/xx) Initial SSN (xxx-xx-xxxx) Requirements for Acceptance into the Teacher Education Program 1. A minimum of 2.50 cumulative G.P.A. 2. A total minimum of 2.50 GPA in University Seminar, College Writing and Quantitative Reasoning (Core) with no grade lower than a ‘C’ (a grade of ‘C-’ or lower is not acceptable). 3. A 2.5 grade-point average in the teaching major, minor, professional area, and “Prerequisites for Elementary Methods Courses” with no grade below a “C” in any of these areas. 4. A record free of, “conviction of, entry of a guilty verdict, a plea of guilty, or a plea of no contest to a criminal offense involving moral turpitude in this state or any other state or country,” (Montana Annotated Code, Sec. 20-4-110). In order to meet the requirement for question #3 (above), you need to answer the following questions: a. Have you ever been convicted of a crime more serious than a minor traffic violation? This disclosure must be made irrespective of whether the record was sealed or expunged, you served a sentence and had your civil rights restored, the sentence was deferred or suspended, or the charge was dismissed after conviction. Yes No If your answer to the above question is a “Yes”, explain fully below, specifying the nature of the offense(s), the date(s) it/them occurred, the name and location of the court (s), and the sentence(s) imposed. This disclosure must be made irrespective of whether you served a sentence and had your civil rights restored. Use additional pages if necessary. b. Are you currently on probation, deferred prosecution, suspended sentence? Yes No If your answer to the above question is “Yes”, explain the circumstances and include the restrictions imposed by the courts. Use additional pages if necessary. Schools will require a criminal records check before placement in public schools. MSU will receive your complete criminal record before placing students. I hereby certify that the above information is true and correct, and I understand that any misrepresentations on this application may be grounds for denial of the application. By signing below, I acknowledge that all the information is accurate, and I give the Montana State University Education Department permission to verify any information provided. ____________________________________________________ Signature _______________________________________ Date Catalog: 2004-2006 Agricultural Education Broadfield Montana State University Secondary Teacher Education Preparation Program ID: Name: Social Security # Date: Last Name First Name Initial Local Address: m/d/yr Phone: Street City State Zip Degree: Subject College Degree Completed College Degree Sought Academic Courses Substitution Courses # Course Title AGED 105 Microcomputers in Agriculture 3 AGEC 210 Econ of Ag Business 3 AGED 333 Construction Technology 3 AGED 355 Teaching Practices 1 TE 406 Curriculum & Facilities Planning 3 AGED 251US Leadership Dev for Agribusiness 3 AGED 253 Ag Ed in Public Schools 3 AGED 314 Power Systems Oper Control CR Grade Subject # Course Title CR Grade 3 AGED 316 Agricultural Trans Systems 3 AGED 400 Seminar 1 ARNR 100 Intro Animal Science 3 ARNR 101 Principles of Range Management 3 ARNR 102 Principles of Range Mgmt. Lab 1 ECON 101IS Economic Way of Thinking 3 MET 315 Welding I 3 LRES 201 Soil Resource 3 VTMB 271 Func Anatomy of Dom Animals 4 PS 102CS Plant Sci, Resources & Environ 3 ARNR 320 Animal Nutrition 4 PSPP 234 Hort Sci and Technology 3 TE 207 Materials & Processes 4 Take One of the Following: PS 318 Biometry 3 STAT 216Q Elementary Statistics 3 Electives: Subject # Take One of the Following: HDCF 150IS Lifespan Human Development 3 HDCF 160 Course Title CR Grade Subject # Course Title CR Grade Hum Dev: Conception to Adol 3 Secondary Professional Preparation EDCI 102 In-School Experience 1 EDCI 209 Ed Psych & Adolescent Dev 3 EDCI 320 Found of Instruct Computing 2 EDCI 360 Foundations of Assessment 2 HDHL 106 Drug/Health Issues for Educ 1 EDSD 363 Multicultural Education 1 EDSD 452 Methods of Teach AG & TE 3 AGED 4XX Sp-Profess in Agric 2 HDCF 356 Exceptional Needs (0-21) 3 EDSD 410 Student Teaching 10-12 EDSD 413C Professional Issues 2 MATH ENGL 121W College Writing I 3 COM* 110US Intro to Public Communi cation 3 *May take approved courses with the letters US for University Seminar Core. For Office Use Only: First Aid with CPR Paraprofessional Experience Disclosure Statement _____________________________________________________________________________ Student's Signature ________________________________ Date _____________________________________________________________________________ Advisor’s Signature ________________________________ Date _____________________________________________________________________ ____________________________ Certification Officer's Signature Date For Use When Completing Student Teaching Application: * Taking this course Spring Semester ** Taking this course Fall Semester or Summer Semester