CURRICULUM WORKSHEET
FOR TEACHING LICENSE
Dragon ID#: ______________________________
Student: _______________________________________________________________________________________________
Last Name
First
Middle/Maiden/Other
Phone: __________________________________
Perm Address: ________________________________________ City: __________________ St: _____ Zip: ___________
I will be graduating at the end of:
FALL
SPRING
(Please circle one)
SUMMER
Previous Degree Information: (Bachelor’s degree or higher only)
Degree: ________ Date Earned: _________________ University/College: ____________________________________
Type of License:
Original/First time license application
Adding program to current teaching license
Previous Licensure: Area__________________________________ State(s) ___________________________



No license application will be processed unless this curriculum worksheet is signed and on file
Licensure Title:
List the EXACT title for each licensure program below. (Titles found on following page)
Licensure Title
Major
Teaching
Level
Other
Minor
Coordinator Signature
Date
1.
2.
3.
Education Requirements_____________________________________________________ Dr. David Tack
**** (Secondary/K-12 Education Majors ONLY) ****
Mid-Level Endorsement:
(Elementary Education ONLY) (see listing on following sheet)
NOTE: In Progress AND Licensure Title, Endorsement Area & Teaching Level information listed on next page
Mid-level Endorsement Area/s
Teaching Codes/Levels
Date
1.
2.
Student Teaching (Check Grade Level)
*
K
1
2
3
4
5
PPST/MTLE Basic Skills



6
Number of Weeks _____
7
8
9
10
11
12
MTLE Pedagogy and Content
Passed / Date Passed: ____________________
Failed
Scheduled to Retake: _______________
Note: PPST tests taken on or after 9/1/2010 are not valid for
Minnesota License
-over-



Passed / Date Passed: ____________________
Failed
Scheduled to Retake: _______________
Curriculum Worksheet for Teaching License-Remaining or In-Progress Courses
Spaces below should be used to list any in-progress or remaining courses to fulfill requirements for programs listed on the front of this form.
Departments, which use their own worksheets or checklists for program requirements, may attach such forms instead of using these spaces (for
example, Music or Special Education endorsements).
Program:
Subject
No.
Title
Credits
Term
LICENSURE / SPECIALTY AREA / TEACHING LEVEL CHART
Licensure Program Titles and
Teaching Levels
Pathologists (08)-Grad level only
Physical Education (09)Physical and Health
Academic and Behavioral Strategist Disorder (09)
Autism Spectrum Disorder (13) – Grad level only
Chemistry (12)
Communication Arts / Literature (11)
Disabilities (13)-Grad level only (after 1/2013 - B-12
(13)
Physics (12)
Reading (09) Graduate level only
Developmental / Adapted PE (08) (?)
Developmental Disabilities (09)
Science (10)
School Psychologist (08)
School Social Worker (08)
Social Studies (11)
Early Childhood Education (02)
Early Childhood – Special Education (01) –Grad level
only
Visual Arts (09)
World Languages and Cultures (09)
Earth Science (12)Ed Speech-Language
Elementary Education (07) see Endorsement Areas
Endorsement Areas
Teaching Levels
Communication Arts & Literature (04)
Mathematics (04)
01
02
03
04
07
08
09
10
11
12
13
Emotional Behavioral Disordered (09)
English as a Second Language (09)
Health Education (11)
Learning Disabilities (09)
Life Science (12)
Mathematics (11)
Music – Instrumental and Classroom (09)
Music – Vocal and Classroom (09)
Updated 7.1.2015
2
Birth to Age 6
Birth to Grade 3
Kindergarten
Endorsement: Grades 5-8
Elementary: Grades K-6
PreKindergarten – Gr. 12
Grades K-12
Grades 5-8
Grades 5-12
Secondary: Grades 9-12
Birth to Gr. 12