Teacher Education Program

 

Application

Application for Admission to the Teacher Education Program (TEP)

Name:                                                                                                              
Last                            First                  Middle                        Maiden

Social Security No:                            Date of Birth:                
Sex:              Race:             
Permanent                                               Local                                         Address:                                                  Address:                                                     City           State           Zip                     City       State     Zip
Phone:                                        
County                                                                 UMPO:                               
Phone:                               

Date Entered College:                 Date Entered UM:                  Advisor:                                           

Cert. Level (Circle):ECE   ELEM   ECE/ELEM   ELEM/Coll  HS P-12
                                 (P-3)   (K-6)     (P-6)               (K-6)           (6-12)

Teaching Field(s) (Completed by High School, P-12 students only)

(1):                                         
(2):                                                      
(3):                                                     

Other Institutions Attended:                      Date(s)

                                                                                                
                                                                                              

I understand that a felony conviction may preclude the possibility of gaining Alabama certification even though, in the absence of such knowledge, UM may have recommended certification.

                                                                                            
Signature of Applicant                                           Date of Application

Office Use Only

ECE, ELEM, ECE/ELEM and ELEM/Coll  ______ C or better in all Gen. Studies courses.

English/Speech Grades:COMS 101        ("C" or better)
                               ENG 101         ENG 102             
General Education Hours                   (48)MUS (36)

General Studies GPA (2.5) Teaching Field GPA (2.5)
Professional GPA (2.5)     Teaching Field #2 GPA (2.5)

Total Earned Hours (60)

ED 401 or MUS 401                  ("C" or better)

Team Interview:  Date                                Score                (17 or better)
Writing Exam:     Date                                Score             (4) 

Date of Deficiency Notice                    Date of Admission                         
                                (if applicable)

UM’s ADA STATEMENT: It is the policy of the University of Montevallo to afford equal opportunity in education to qualified students. If you have a disability that may prevent you from meeting course requirements, contact the instructor immediately to file a Student Disability Statement and to develop an accommodation plan. Course requirements will not be waived but reasonable accommodations will be developed to assist you in meeting the requirements. You are expected to work with the instructor and the Office of Student Support Services to develop and implement a reasonable accommodation plan.

APPLICATION FOR THE EDUCATION INTERNSHIP

Term Requested:                               Year Requested:                            
                               (Fall or Spring)

Name:                                                                                                           
              Last                  First                Middle              Maiden

Social Security #:                                                 Advisor:                       

Date Entered College:                          Date Entered UM:                      

Cert. Level (Circle): ECE   ELEM   ECE/ELEM ELEM/Coll HS P-12
                                   (P-3)    (K-6)    (P-6)              (K-6)        (6-12)

Teaching Field(s): (High School, P-12 only)

(1):                                                     

(2):                                                      

(3):                                                      

Permanent                                                Local                                          
Address:                                                   Address:                                     

                     City         State          Zip                     City        State       Zip

Phone:                                                       Phone:                                    
UMPO:                                    
E-Mail Address:                                                

Address During the Internship :                                                         
                                                                                                                   
                                               City               State                    Zip
                                              Phone:                               

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Preferred Grade Level(s):

First Preference:                                                                                             
Second            (grade range/subject)

Preference:                                                                                         
                    (grade range/subject)                

I understand that immoral conduct, unbecoming or indecent behavior, or conviction of a felony may preclude the possibility of gaining Alabama Certification even though, in the absence of such knowledge, UM may have recommended certification.

 
                                                                                                                                            Signature                                                                     Date of Application

Return to: Office of Teacher Education Services, Wills 207