Graduate Educator Preparation Program Admission Application Personal InformationName (complete, legal name)*Please provide your name as it appears on your driver's license. First Middle Last Student ID (H#)This field is hidden when viewing the formDate of BirthMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender*Please Select OneFemaleMalePhone*Email* Address*U.S. Residential Address Required Street Address Apt / Unit City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Ethnicity*Please indicate your ethnicity. This information is used for statistical purposes only by the Texas Education Agency. Admission to the Educator Preparation Program is determined without regard to ethnicity.Please Select OneHispanic or LatinoNon-Hispanic or Non-LatinoRace*Please Select OneAmerican Indian or Alaska NativeAsianBlack or African-AmericanHispanic or LatinoNative Hawaiian or Other Pacific IslanderWhiteTwo or more racesPlease indicate your race. This information is used for statistical purposes only by the Texas Education Agency. Admission to the Educator Preparation Program is determined without regard to race.Program*Please Select OneGraduate (earning MEd with Curriculum & Instruction)Graduate (earning MEd with Initial Certification)Alternative Certification Program (ACP)Graduate (earning MEd with Additional Certification)Certification Desired*Please Select OneCounselorAdministrationEducational DiagnosticianMaster Technology TeacherReading SpecialistCertification Desired*Please Select OneEC-6EC-6 with Special Education EC-12EC-6 with Bilingual Education4-8 Math4-8 Science4-8 Social Studies4-8 English Language Arts7-12 Math7-12 Science7-12 Social Studies7-12 English Language Arts7-12 Speech7-12 Physical ScienceAll Level ArtAll Level MusicAll Level Physical EducationAll Level SpanishCertification Desired*Please Select OneEC-6EC-6 with Bilingual Education4-8 Math4-8 Science4-8 Social Studies4-8 English Language Arts7-12 Math7-12 Science7-12 Social Studies7-12 English Language Arts7-12 Speech7-12 Physical ScienceAll Level ArtAll Level MusicAll Level Physical EducationAll Level SpanishAll Level Special EducationWriting AssignmentCandidate's appropriateness for Certification Sought:*Complete the following writing assignment as directed below. Criteria: Assignment must be in paragraph form using formal Standard English and fit in the space below. This assignment should represent your BEST professional writing. Explain in 600 characters or fewer: If seeking initial teacher certification, please address why you would like to be a teacher. If you are already a certified teacher, please address why you are seeking to continue your education and why you have chosen the particular Master's degree selected above to pursue.Academic HistoryIf seeking MEd (initial certification only) or ACP Initial Certification, please indicate your highest earned degree:Degree Type*Please Select OneBachelor'sMaster'sDoctorateUniversity*Undergraduate Major(s)*Undergraduate Minor(s)Certification Level Desired*All certification areas except EC-6 and Special Education (if intending to teach in EC-6 grad levels) require a minimum of 12 hours in the content area if PBC or 24 hours, with 12 being upper level, if MEd. Students may also qualify to teach a content area by taking and passing a Pre-Admission Content Test (PACT) through TEA.Please Select OneEC-6th Grade4th-8th Grade7th-12th GradeAll-LevelSpecialization Area Desired*Indicate your desired area of specialization.Please Select OneEC-6 Core SubjectsEC-6 Bilingual GeneralistSpecialization Area Desired*Indicate your desired area of specialization.Please Select OneEnglish Language Arts and ReadingScienceSocial StudiesMathematicsSpecialization Area Desired*Indicate your desired area of specialization.Please Select OneCommunication/SpeechComposite Social StudiesEnglish/Language ArtsHistoryJournalismMathematicsLife SciencesPhysical ScienceComposite ScienceSpecialization Area Desired*Indicate your desired area of specialization.Please Select OneArtMusicP.E.SpanishSpecial EducationCourses*List all courses taken in the Content Area if 4-8, 7-12 or All-Level.Total # of hours in the Content Area.*Total # of upper-level hours (3000 & 4000)*AcknowledgementAcknowledgement of Acceptance*By checking the box below, I hereby acknowledge my receipt of the below information. I also understand that my performance evaluations for field work, clinical teaching, and/or student teaching will be shared with the campus administrator. In accordance with Article 6252-13c, Texas Civil Statues, the Commissioner of Education may suspend or revoke a teaching certificate or refuse to issue a teaching certificate for a person who has been convicted of a felony or misdemeanor for a crime which directly relates to the duties and responsibilities of the teaching profession. All applicants for Texas certification will be screened for a record of felony or misdemeanor conviction through the Texas Department of Public Safety (DPS) and Home Land Security. NOTICE: All potential certificate applicants with criminal felony or misdemeanor convictions should contact the Certification Officer immediately to seek clarification of their certification status. I Accept