NU-TEACH Application for Admission

Transcription

1 NU-TEACH Application for Admission Select ONE box only from the available strands in the program: 2120 Campus Drive Evanston, IL Ph. (847) Fax (847) q Elementary grades K-8 Secondary grades 9-12 q Math q Biology q Chemistry q Physics (Requires at least a Bachelor degree in the subject or a related field, ie: accounting=math; engineering =physics; medicine=biology) Name: Birthdate: Last First Middle Initial Mailing Address: Street Address: City: State: Zip: Current Contacts: Phone Number at Mailing Address: ( ) Office/Cell: ( ) Fax: ( ) Address: Permanent Address: Street Address: City: State: Zip: Phone Number at Permanent Address: ( ) Citizenship: FOR OFFICE USE ONLY Date Received U.S. Place of Birth: Other (Name Of Country): _ Type of Visa: APPLICATIONS ARE DUE FEBRUARY 1, 2011 REV 9/24/2010 EMPLOYMENT HISTORY PLEASE INCLUDE IN YOUR APPLICATION A COPY OF YOUR RESUME. Account for all time periods from the start of your professional career to the present, beginning with your most recent activities. Include full-time, part-time, summer, and volunteer work experience. BACKGROUND INFORMATION If you answer Yes to any of the following questions, please explain fully in the space below: 1

2 1) Have you ever been suspended or required to withdraw from any school or college? Yes No 2) Have you ever been dismissed from any branch of the Armed Forces of the United States under conditions other than honorable? Yes No 3) Have you ever been convicted of a felony? Yes No 4) Have you ever been convicted of any sex or narcotics offense? Yes No 5) Have you ever had a teaching certificate revoked or suspended? Yes No 6) Have you ever been the subject of a child abuse or neglect report? Yes No 7) Are you in default on either child support payments or an Illinois student loan? Yes No 9) Have you ever been a participant in an AC (Alternative Certification) program? Yes No If Yes to any of the above questions, please indicate which one(s), and please explain: _ If you have any physical or emotional challenge that you wish to call to our attention, please state so and indicate any kind of accommodation you may require: COLLEGES AND UNIVERSITIES ATTENDED Cumulative undergraduate grade point average of institution that granted you a degree: GPA out of (max) Cumulative graduate grade point average if applicable: GPA out of (max) ** IT IS YOUR RESPONSIBILITY TO REQUEST AN OFFICIAL, SEALED TRANSCRIPT FROM THE REGISTRAR OF EACH INSTITUTION TO BE INCLUDED WITH YOUR APPLICATION PACKAGE.** List in chronological order all colleges and universities attended, including those attended during summer terms. Please start with the most recent, first: Institution Attended Location of Years of Degree Mo./Yr. Major/Minor School Attendance fields of study 1. to 2. to 3. to 4. to Honors received or other evidence of high scholarship (Phi Beta Kappa, Beta Gamma Sigma, etc.): COLLEGIATE EXTRACURRICULAR AND PROFESSIONAL ORGANIZATIONS Activities (most important ones first) Dates Offices held, if any Successful interns may be expected to add to the culture of their site by contributing to the school s extracurricular program. Indicate here, the area where you would be interested in serving as a coach or sponsor; 2

3 Interscholastic Sports (Specify): Extracurricular Activity: ESSAY RESPONSES Please respond to each of the first five of the following essay questions, and one of the two questions numbered 6, for the strand (elementary or secondary) for which you are applying. Use separate sheets for each response (at least one full typewritten page per question, but not more than two). Please DO NOT staple your essays together. 1. Describe an issue about which you feel passionate, or describe a skill, avocation or ability you have which you find rewarding and tell how you expect this to influence your teaching. 2. Describe what you believe are the opportunities and challenges of working with urban school children. 3. How have you arrived at identifying yourself as a teacher? 4. Describe an important learning experience of your life and how you handled it. 5. Describe a teacher who influenced you. For elementary strand applicants, only; 6. Describe in detail a recent teaching experience you had (in church, school, or business) the task before you, how you approached that task and what the experience revealed to you about teaching. For secondary strand applicants, only; 6. Think about the subject matter you wish to teach. Describe the job related or volunteer situations in which you have used the subject you wish to teach. OPTIONAL PERSONAL DATA (Furnishing or failure to furnish this information will not affect the admission decision.) United States Citizens and Permanent Residents Only White (non-hispanic) African-American (non-hispanic) Puerto Rican Mexican American/Chicano Asian or Pacific Islander American Indian or Alaskan Native Hispanic (not Chicano, not Puerto Rican) Multi-racial Other: Male Female REFERENCES Applicants are required to submit three letters of reference in signed and sealed envelopes. Good sources of reference would be: employers, professors, fellow employees, etc. These references should include, if possible, at least one addressing the applicant s suitability for teaching. PLEASE REFER TO THE ATTACHED NU-TEACH LETTER OF REFERENCE FORM 1. Name: Position: Address: City: State: Zip: 2. Name: Position: Address: City: State: Zip: 3. Name: Position: Address: City: State: Zip: 3

4 NU INTERN FELLOWSHIP AWARD Fellowship monetary awards may be available in amounts ranging from $3500 to full tuition Fellowships. Are you interested in applying for an NU Intern Fellowship? Yes No If you have answered Yes to the preceding question, in essay form, identify your goals as a professional educator, and explain why you believe you should be awarded a Fellowship. APPLICANT STATEMENT OF CERTIFICATION I certify that all statements made in this application are correct, and I realize that all documents submitted in support of this application become the property of the NU-TEACH Program. Applicant Signature Date APPLICATIONS ARE DUE FEBRUARY 1, 2011 I have enclosed with this application the following materials: All transcripts Three letters of reference Essay responses Resume ISBE test scores/materials I HAVE SCANNED/ ED OR FAXED MY APPLICATION PER THE INSTRUCTIONS BELOW Application and supporting material should be SCANNED/ ED OR FAXED TO BOTH: 1) Sylvia Smith-DeMuth and 2) Mark Glenn s-smith1@northwestern.edu m-glenn2@northwestern.edu FAX FAX

5 NU-TEACH Application for Admission LETTER OF REFERENCE FOR OFFICE USE ONLY Date Received Administrative Coordinator 2120 Campus Drive Evanston, IL Ph. (847) Fax (847) Name of Applicant (print or type) Last First Middle I. To the individual completing this form: The person whose name appears above has applied for admission to the Northwestern University NU-TEACH Alternative Teacher Certification Program. Please answer the questions below in as specific and candid manner as possible, particularly noting maturity, purposefulness and initiative. Your comments will be an important factor in the admission decision. Place the completed recommendation in the envelope addressed to the candidate, write your name across the seal, and return it to the candidate. Your comments will not be disclosed to the applicant and will be available only to those involved in our admission process. The letter of recommendation will be destroyed when it is no longer needed for admission purposes, and it will not become part of a permanent record. If you do not feel comfortable with the reference process as described, please inform the candidate that you will be mailing the recommendation directly to us. Thank you. Name of the individual completing this form (print of type) Position or Title Organization Address State Zip Telephone ( ) How long have you know the applicant? years Under what circumstance? 2. What three adjectives would you use to best describe the applicant? Take one of those adjectives and develop in an essay your observation of this attribute in the applicant. 3. What do you consider the applicant s most outstanding talents or characteristics? 4. To what extent does the applicant demonstrate originality and independence in thinking? Where have you observed this? 5

6 5. Please describe this applicant s interactions with co-workers. If you can, give specific examples of the applicant s leadership capability. 6. The Admission Committee would appreciate any additional statement you may wish to make concerning the applicant s capacity for graduate work and potential for becoming a responsible and successful teacher in urban schools. 7. In comparison with other people that you have know, rate the applicant with respect to the following qualities: Below average (Bottom1/3) Average (Middle 1/3) Good (Top 1/3) Unusually Good (Top 15%) Outstanding (Top 5%) Truly Exceptional (Top 2%) Inadequate opportunity to observe Intellectual Ability Maturity Leadership Potential Personality/Ability to get along with others Written Skills Oral Skills Suitability for teaching in an urban environment 8. Strongly Recommend that this applicant be admitted to Northwestern University NU-TEACH Program Recommend Recommend Recommend Signature Date Since your evaluation will become part of the applicant s formal application, your prompt response in returning this form is essential to a timely decision. Thank you for your assistance. 6