Urbana University
Application for Admission
Post Baccalaureate Program in Education
Admission Requirements
1.
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Hold a baccalaureate degree from a state-approved, nationally accredited college or university.
Have an undergraduate GPA of 2.0 or higher based on a four-point scale to be admitted to the university.
Have an undergraduate GPA of 2.3 or higher based on a four-point scale to be admitted to the College of Education. Students with a GPA of
2.0 to 2.2 will be considered for conditional admission to the College of Education.
Submit official transcripts from all colleges or universities attended to the Office of Admissions (address on back).
Submit completed Post Baccalaureate Program application by FAX, scan or postal mail to the Office of Admissions (address on back).
Please read and follow directions carefully. Type or print clearly.
Year you wish to enter
□ Fall Term 1 (August)
□ Fall Term 2 (October)
______________
□ Spring Term 1 (January)
□ Spring Term 2 (March)
Post Baccalaureate Licensure Program
Endorsements
Initial licensure and additional licensure
□ Early Childhood Generalist
□ Middle Childhood Generalist
□ Early Childhood (PK-Grade 3)
□ Summer Term 1 (May)
□ Summer Term 2 (June)
□ Intervention Specialist (Grades K-12)
Mild/Moderate
□ Middle Childhood (Grades 4-9) select two
□ Language Arts □ Mathematics
□ Science
□ Social Studies
Adolescence to Young Adult: (Grades 7-12)
□ Integrated Language Arts
□ Integrated Mathematics
□ Integrated Social Studies
Workshops
□ Online
□ 1 credit hour
□ 3 credit hour
Title: _________________________________________
Title: _________________________________________
Title: _________________________________________
SEEKING AN ENDORSEMENT? Endorsements require an Ohio teaching certification/license (endorsement applicants only)
Do you hold a teaching certification/license? □ Yes □ No
□ Valid? □ Expired? If so, when ? __________ □ Ohio license
□ other ___________
Licensure type: ______ PK-3 ______ 4-9 ______ 7-12 ______ Intervention Specialist ______ Other _____________________________________
PERSONAL DATA
Last Name______________________________________________ Legal First Name________________________________ Middle Initial
Preferred given Name or Nickname
Permanent home address: Number and Street
City ____________________________________________________ State ____________ ZIP ___________________ County
Home Telephone number with area code (
Date of birth:
) _______________________________ Cell Phone with area code (
)
Month/Day/Year _____________________________ Social Security Number (Optional)
E-mail address ______________________________________________________________________________________________________________
How do you prefer to be contacted? (check one)
APPROVED FOR USE SPRING 2013
□ home phone
□ cell phone
□ email
□ postal mail
ACADEMIC INFORMATION
Please list below any colleges/universities attended.
Please request official college transcripts to be mailed directly to the Office of Admissions.
No evaluation for admission will be made until these transcripts are received.
Name of college (s)
Location (City, State, ZIP)
Major
Degree Earned
1._________________________________________________________________________________________________________________________________________
2._________________________________________________________________________________________________________________________________________
3._________________________________________________________________________________________________________________________________________
4._________________________________________________________________________________________________________________________________________
OPTIONAL INFORMATION
*Information on sex, age, ethnic origin and citizen status is collected for compliance records in connection with federal regulations pursuant to the Civil
Rights Act of 1964 Executive Order 11246 as amended by Executive Order 11375 and Title IX of the Educational Amendments of 1972 and part 86, 45,
C.F.R, and will not be used to discriminate in admission or to participate in any of the educational programs or activities offered at Urbana University.
Sex: □ Male
□ Female
Are you a U.S. Citizen?
Please check one *(optional) □ American Indian/Alaskan Native □ Asian American □ Black, Non-Hispanic
□ Hispanic □ Pacific Islander □ White, Non-Hispanic □ Multi-racial □ Other
□ Yes □ No
If no, please state country of Citizenship _____________________________________________________
ACKNOWLEDGEMENT & WAIVER OF ACCESS RIGHTS
In accordance with the provisions of the Family Educational Records and Privacy Act of 1974 as Amended, the undersigned applicant voluntarily
relinquishes his/her right of access to the application file submitted in accordance with the requirements for admissions, in the event he/she is admitted
to Urbana University, and as a student applies for access to the file held in his/her name. The undersigned certifies by his/her signature that he/she
has made this waiver in order to facilitate an objective evaluation of his/her character and potential as a student at Urbana University and that
he/she is aware this waiver is in no way executed as a requirement of admission or the granting of financial aid.
In submitting this application, I agree to:
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Comply with all conditions as outlined in the current University Catalog, Student Handbook, or as otherwise prescribed.
Grant the University permission to use the student’s name in University literature and for public relations purposes.
I certify that this information is true and complete to the best of my knowledge. Falsification of information on this application could jeopardize
acceptance or enrollment. I authorize any schools or colleges I have previously attended to release official transcripts to Urbana University.
Applicant Signature _________________________________________________________________
Date_________________________
(Required)
Please review your application. Make sure you have responded to all questions.
Urbana University admits students of any race, color, religion, ethnic or national origin, age, disability, gender, sexual orientation, or veteran status to all
the rights, privileges, programs, and activities generally accorded or made available to students at the university. It does not discriminate on the basis of
race, color, religion, ethnic or national origin, age, disability, gender, sexual orientation, or veteran status in the administration of its educational policies,
scholarship and loan programs, athletic programs, and other university administered programs.
Mail your completed application and have transcripts sent to:
Steffie Lybeck
Office of Admissions
579 College Way
Urbana, OH 43078
937-484-1278 (phone)
937-652-6871 (fax)
slybeck@urbana.edu
www.urbana.edu
APPROVED FOR USE SPRING 2013