Name:
Address:
Attach resume with your application indicating your educational and professional background
Statement of Purpose
Attach a brief statement of your reasons for undertaking graduate study (including career objectives, motivation for advanced level studies and other pertinent information).
NOTE: Because the Admissions Committee may consider this section to be a sample of the quality of your written expression skills, please formulate your response accordingly.
Certification
Are you currently certified to teach? Yes
What is your current certification? Provisional
No
Life Other
Name of state(s) in which certification is held: ______________________________________
What type of certification do you hold? Elementary
Middle
Secondary
Please initial below.
I understand this program:
 Will not provide initial teacher certification preparation. _______ (initial)
 I understand this program does not guarantee the coursework will meet my state’s requirements for any secondary certification for which I may apply.
_______ (initial)
 Any secondary certification my coursework may meet at my state’s teacher certification agency must be submitted directly to the appropriate agency by me. _______ (initial)