Formal Application to the Teacher Education Program

Formal Application to the Teacher Education Program
Warren Wilson College
Department of Education
Required Attachments:
The Formal Application form for Admission to the Teacher Education Program. Including all
required signatures
The Application Essay (Guidelines for essay are attached to the application packet)
The Candidate for Professional Licensure (CPL) Application Statement
A Health Examination Certificate
This signature page
I am requesting formal admission to the Warren Wilson Teacher Education Program, and I expect to complete the
program with a student teaching placement in my final semester. I understand that student teaching is a full-time
obligation and must be a priority throughout that semester.
 I know that if I am an on-campus resident student I will receive a work scholarship
 Because I may be required to return to campus early for my student teaching, on-Campus housing may need to
be temporarily re-assigned.
 I know that if I live off-campus I will receive a waiver of certain fees from the college (i.e.: room and board).
 I know that my student teaching semester will require me to follow the calendar of the public school to which I
am assigned.
 I understand that as a student teacher I may NOT:
1. Hold an outside job (on or off campus)
2. Take additional courses or independent studies
3. Commit to extra-curricular college activities without making a formal written request that is approved in
advance by the Teacher Education Committee
Candidate Signature: ______________________________ Date: _____________
Revised April 2006
Warren Wilson College
Formal Application for Admission to the Teacher Education Program
Name: ________________________________________
College Box # ____________________
Local Phone: _____________
Permanent / Home Address and Telephone Number:
Semester and Year Planned to Student Teach: ___________________
Semester and Year Planned to Graduate (if different): _____________
WWC QPA (cumulative): _____________ Credit Hours completed: __________
SAT equivalent
ACT equivalent
_____ Reading 176
___ 24 or higher score
_____ Writing 173
_____ Math 173
___550 Math (Praxis I math section
___550 English (Praxis I reading and
writing sections waived)
___1100 combined score
IN ADDITION to this form, you will need to complete an application essay. Guidelines for this composition are available in the
Education Office.
SIGN AND ATTACH “Candidate for Professional Licensure Applicant Statement” regarding your status as a law-abiding member
of the community, NCDPI requirement. The form is available in the Education Office.
Do you have any history of an emotional or physical condition that might affect your performance as a teacher? [If yes, please
attach a separate sheet of description/explanation]:
Total Service Learning Opportunity hours documented to date: _______
SLO Signature
Satisfactory record with the Office of the Dean of Students:
Please note that your name will be sent to the
Dean of Students as well as to the Work
Program Office to ensure that there are no
concerns about your ability to serve as a
responsible adult role model in the public
Satisfactory record with the Work Program Office:
Candidate Signature:
Date of Application:
The Warren Wilson College Teacher Education Candidate is a reflective innovator serving in communities with
head, heart and hands.
Updated April 2006
Warren Wilson College
Department of Education
Formal Application for Admission to the Teacher Education Program
Attach an essay which describes your progress toward the Teacher Education Program goal for all (future)
educators. Be sure to address each of the “Four Envelopes” assessment qualities in terms of what specific
skills and knowledge you have to offer to K-6 or 9-12 schools:
1. Passion for, and commitment to, understanding diverse learners and their learning (What can you
tell us about what you want to do as a teacher, and why you want to teach?);
2. Agility and creativity in teaching built on knowledge of academic disciplines (please include a
description of the topics or subjects that you are most interested in teaching);
3. Initiative and responsibility in promoting and recognizing student learning (What have you
learned about yourself through academics, work, and service in terms of being self-directed and
reliable? What does this tell you about your roles and responsibilities as a teacher?);
4. Self-reliance and collegiality within the teaching profession, balancing individual reflection and
learning from experience with the support and necessary guidance of veteran educators (Are you
ready to be a junior member of a teaching team?)
Your essay must be typed and proofread carefully. If provided in a timely manner, faculty in the Education
Department will advise you in the writing process. You should allow enough time to utilize the Writing
Your complete application will be reviewed carefully by the Teacher Education Committee (which represents
the entire college community). This essay is your best opportunity to introduce yourself and share your ideas
about teaching and learning. You may be required to revise your essay in order to meet Academic Standards.
The Warren Wilson College Teacher Candidate is a reflective innovator serving in communities with heart, head, and hands.
North Carolina Public Schools
Required of all persons upon initial employment, or separation from employment more than one school year,
or deemed necessary by a local school board or superintendent.
(Ref.NCGS 115C-323.)
NAME: _________________________________________________
The above named individual is to be recommended for employment by _________________ (local school
board) in a position of __________________________. In this position, the condition of certain physical
capacities will be of importance. Please examine the areas listed below and report any limitations,
deficiencies or related restrictions.
(continue on back as needed)
By my signature I certify that the above named person does not have any communicable disease,
including tuberculosis, that poses a significant risk of transmission in our schools or would impair this
person’s ability to perform the duties of the job, except as may be noted above. Further I certify that this
person is free of any other physical or mental disability that would impair job performance.
If unable to certify the above, please comment:
DATE __________________
Physician (type or print)
SIGNATURE OF PHYSICIAN_______________________________________M.D.
 yes
 no
Have you ever been convicted of a crime (excluding minor traffic violations)?
 yes
If yes, please attach a letter of explanation and a certified copy of the court proceedings from the court of conviction.
 no
Have you ever had a certificate or license revoked or suspended by any state or other governing body?
If yes, attach a statement giving full details and official documentation of the action taken.
I certify that the information provided in this application is correct and true. I understand that the falsification of any
statement or document will result in license revocation.
Signature __________________________________________
Date ________________________________________________
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