Purdue University North Central
Early Childhood Education Program
Semester applying for:
APPLICATION FOR ADMISSION
Please type or print. This form may not be submitted electronically. Incomplete applications will not be accepted.
Last Name:
Purdue ID Number:
First Name:
Middle Initial:
Primary Telephone Number:
Home Address, City, State, Zip:
Purdue E-mail Address (All e-mail correspondence will be via Purdue account only. It is your responsibility to check it frequently).
Have you taken courses at another college or university?
Yes
No
If so, please provide the PNC Education Department with a copy of your transcripts at the time of application submission.
The following requirements must be completed for admission into the Early Childhood Education Program (Strand 2).
STANDARDIZED TEST REQUIREMENT
Official CASA Scores or verification of an alternate method are due in the Education Department Office by the following dates:
July 1st for Fall Admission and November 1st for Spring Admission
Please list scores for the CASA or alternate method.
Reading:
/220 required
Math:
/220 required
Writing:
/220 required
Alternate methods: SAT Score:
ACT Score:
(Must be at least 1100, excluding Writing)
(Must be at least 24 Composite)
ADDITIONAL REQUIREMENTS
 Please list your Cumulative GPA. (A GPA lower than 2.50 will not be accepted). Cumulative GPA:
 Please list your grades for each of the courses required for program entry listed below. (A grade lower than a “C” will not be


accepted. If currently enrolled in the listed course, indicate CE; if these courses are transfer credits, indicate grade received).
BIO 205 Grade:
MA 137 Grade:
and/or MA 139 Grade:
ENG 101 Grade:
EDST 270 Grade:
EDCI 276 Grade:
PSY 120 Grade:
PSY 235 Grade:
Please list your grades for each course, if applicable. The below listed courses are NOT required for program entry. (A grade
lower than a “C” will not be accepted. If currently enrolled in the listed course, indicate CE; if these courses are transfer credits,
indicate grade received).
EDCI 270 Grade:
EDCI 311 Grade:
EDCI 322 Grade:
Submission of this completed form (Application for Admission), with signature, by specified due date below. Incomplete
applications will not be considered.
CRIMINAL HISTORY
Are you currently under investigation or is disciplinary action pending against any licensure in any state, or territory of the US?
Yes
No
Have you ever been convicted, entered a plea of guilty, nolo contendre (no contest), or have you ever been sentenced, served time in
jail or prison, or had probation or sentence deferred in any felony or undesignated offense?
Yes
No
SIGNATURE
By signing this form, 1) I certify that the information provided on this application is accurate and true; 2) I agree to abide by the
policies, rules, and regulations of Purdue University North Central; 3) I am responsible for providing the PNC Education Department
with proof that I meet all the Education program application requirements by July 1st for Fall Program Admission or by November 1st
for Spring Program Admission; and 4) I am aware that falsified information may result in denial of admission and/or dismissal from
the Education program at Purdue University North Central.
Signatures in the box below are required for admission.
Date ______________________________
Candidate’s Signature ______________________________________________
Date ______________________________
Advisor’s Signature ________________________________________________
APPLICATION DUE DATES
Applications for admission into the Early Childhood Education Program
(Strand 2) are due by the following dates:
July 1st for Fall Admission and November 1st for Spring Admission
Rvsd. 11.13.15
Submit to the Education Office
TECH 205
ece.prog.app
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PURDUE UNIVERSITY NORTH CENTRAL
Early Childhood Education Program
APPLICATION FOR ADMISSION
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Please write a statement of intent in the space provided below.
(Why did you choose this major? What are your plans after you complete this degree?)