College of Education & Human Services Educator Preparation Institute

Transcription

1 College of Education & Human Services Educator Preparation Institute Educator Preparation Institute APPLICATION Please complete the following application and mail it, along with the $30 application fee, Copy of your Statement of Status of Eligibility and your official transcripts to: University of North Florida, 1 UNF Dr., Attn: Admissions, Jacksonville, FL You may also hand deliver your application materials directly to One Stop Student Services located at: Hicks Hall, Building 53 Suite 1700 BASIC INFORMATION Last Name: First Name: Middle Initial: IMPORTANT! You must provide your legal name as it appears on your Social Security Card. Date of Birth: Social Security #: Race (check all that apply): Ethnicity (select one): Gender: American Indian or Alaskan Native Black or African American Hispanic or Latino Female Asian Native Hawaiian or Other Pacific Islander White Not Hispanic or Latino Male Are you a US Citizen? Yes No* *If no, please indicate country of citizenship: Are you fluent in any language(s) other than English? Yes* No *If yes, please indicate in which language(s) you are fluent: Mailing Address: Apt/Unit #: City: State: ZIP: Home Phone: Cell Phone: Work Phone: Address: Are you a current or former UNF student? Yes* No If yes, what is your N#? _ *If yes, what dates did you attend UNF? *If yes, what degree did you seek?

2 EDUCATION AND EXPERIENCE EDUCATION: DEGREE EARNED MAJOR COLLEGE ATTENDED Bachelor s Degree Master s Degree Specialist s Degree Doctorate Degree CUMULATIVE GPA DATE EARNED PREVIOUS EMPLOYMENT: List your current, or most recent, employment history first 1. Company Name: Job Title: Are you currently employed here? Yes* No *If yes, how many hours per week do you work? Describe your role: 2. Company Name: Job Title: Describe your role: TEACHING EXPERIENCE: Are you currently teaching? Yes* No Have you ever taught in the past? Yes No** *If you are currently teaching, or have previously taught, please complete the information below. Provide your current, or most recent information. **If you have never taught, leave the information below blank, and continue to page 3. You will be required to participate in a field-experience throughout the program. Please refer to the EPI Program Description on the EPI web page ( for full details. School Name: City: State: County: Principal Name: School or District Mentor Name: Grade Level: Subject Area(s): Year you began teaching: Are you classified in the district as a: (Select any that apply) 1 st Year 2 nd Year 3 rd Year Other How did you hear about UNF s EPI Program? Website Friend/Family School District Information Session Former Participant Other

3 CERTIFICATION Have you completed your school district s New Teacher Program? Yes* No N/A not teaching *If yes, what month and year did you complete it? _ *If yes, please include a copy of your final document verifying completion along with this application. Have you completed and passed a Reading Competency 2 course? Yes* No *If yes, you must provide a copy of your certificate along with this application. Please indicate if you have passed any of the following portions of the Florida Teacher Certification Exam (FTCE): GK Reading GK Math GK English GK Essay Professional Education Exam Subject Area Exam SHORT ESSAY Please answer the following short essay questions in words each. Please attach additional paper if necessary. 1. Describe the role of an educator in K-12 public education? 2. Discuss some behaviors and practices of teachers who value social justice and educational equity?

4 BACKGROUND CHECK Are you currently, or have you ever been, charged with, or subject to, disciplinary action for scholastic or any other type of misconduct at any educational institution? Yes* No Have you ever been convicted, and/or, do you have charges pending of any criminal offense, other than a minor traffic violation? Yes* No *If your answer to either of these questions is Yes you are required to provide a written explanation of the event. You may be required to furnish UNF with statements from your school administration or legal representation and copies of all official documents explaining the final disposition of the proceedings. If your records have been expunged pursuant to applicable law, you are not required to answer Yes to these questions. You will also be fingerprinted by the school district in which you will do your practicum, teach, as well as for the state of Florida when you apply for a Professional Teaching Certificate. If you answered Yes to either of the questions, it is possible you may not pass one or all of those background checks. If you have questions, please see the representative school district website. ACKNOWLEDGEMENT OF REQUIRED PROGRAM HOURS The UNF EPI program requires a total of 300 hours. These hours are accomplished through the following activities: site-based sessions, practicum hours, online Reading Competency 2 course, and outside readings. By initialing below you acknowledge that you understand the time requirements for the UNF EPI program, and that you are able to participate in the program for the required amount of time. Initials: Date: SIGNATURE IMPORTANT: You must read and sign this section in order to complete your application to this university. I understand and agree that I will be bound by the University s regulations concerning application and tuition deadline dates and admission requirements. I further agree to release any transcripts, student records, and test scores to UNF and allow them to be used for State Reporting by the Florida Department of Education. I certify that the information given in this application is complete and accurate, including credits or degrees earned. If admitted, I hereby agree to abide by the policies, rules, and regulations of the University. Should any of the information I have given change prior to my entry to the University, I will immediately notify the Office of Admissions. I understand that any false information given in the application may result in denial of application or dismissal from the program. I understand that all accepted candidates will be required to complete a fingerprinting process and submit a background check prior to the start of the program. Accepted candidates must report to fingerprinting on the assigned date and time of the appointment made by the EPI Office and applicable school district. SIGNATURE DATE _

5 EPI APPLICATION SUBMISSION DIRECTIONS: Submit the following items to: University of North Florida 1 UNF Dr., Attn: Admissions Jacksonville, FL Completed UNF EPI Application $30 Application Fee (cash or check made payable to: The University of North Florida) Copy of your current Statement of Status of Eligibility Official College Transcripts (sealed) Copy of Temporary Teaching Certificate (Current Teachers) Copy of Official Score Report (if applicable) You may also hand deliver your application materials directly to One Stop Student Services located at Hicks Hall, Building 53, Suite For more information please visit