Attached is certification of negative results of TB testing

							OFFICE OF UNIT ASSESSMENT                                                                                        101 BRADDOCK ROAD
FROSTBURG STATE UNIVERSITY                                                                                       FROSTBURG MD 21532
COLLEGE OF EDUCATION                                                                                                     301-687-3184
                       Application for Admission to PHASE I of the Teacher Education Program
                                              Catalog Year 2001-2003
Name:                                                     Date:
Local Address:                                            Phone:
                                                          Advisor:
Permanent Address:                                        Phone:
                                                          Transfer Institution
Social Security No:                                       Catalog Year
Directions: Complete and return to the Office of Unit Assessment, Room 215, Framptom Hall. When completing this
   application, record specific grades, number of hours, grade point average, and scores. Transfer students are required to
   bring transcripts from previous institution(s) and a copy of the final transfer credit evaluation. If completing any listed
   requirements this semester, please write "current semester" in the blank provided.
                                                                                                                    Circle Yes/No
                                                                                                                    where appropriate.
Requirements:                                                                                                   Fill In:
1.     Number of credit hours completed by end of current semester including transfer credits.
        (45 credit hours are required before entrance into Phase I.)
2.     Cumulative grade point average (GPA) in FSU and transfer courses prior to Phase I entrance.              GPA 2.5+
3.     Declared Major
       Declared Specialization (Elementary Majors)                                  (Get form from
       Educational Professions Department.)

4.     Completion of Technology Inventory Screening to identify candidate problems with                         Tech. Yes/No
        use of technology (Tech.).

5.      Grade of C or better in the following courses (write grade beside course)
     a. ENGL 101/111
     b. MATH 206 for ECE/ELEM & ELEM or Basic Math Requirement for K-12 and Secondary.

     c. ECE/ELEM Majors completion/concurrent enrollment of ECED 150 or transfer equivalent.

     d. Completion/concurrent enrollment of EDUC 100 for Secondary, ECE/ELEM and ELEM majors.

     e. Completion of EDUC 201 for K-12 and completion/concurrent enrollment
        for Secondary, ECED/ELEM and ELEM.
6.     Documentation of meeting the State of Maryland's passing cut off scores on PRAXIS I:
       Reading                (177)           Writing               (173)
       Math                   (177)        Combined __________ (527)
7.     Attached is certification of negative results of TB testing.                                             Yes/No
8.     Documentation of 20 hrs. of services and a 350 word essay consisting of three paragraphs                 Yes/No
        (past experiences with diverse populations, what I learned, and impact on my teaching) on
        the experience with two diverse populations reflecting on differences among individuals and
        groups based on race, ethnicity,socioeconomic status, gender, language, exceptionalities,
        sexual orientation, or geographic region.
9.     Attached is the completed consent and release form.                                                      Yes/No

Applicant's signature
       Positive recommendation by EDUC 100 instructor ECE/ELEM, ELEM, and Secondary majors.          Yes/No
       This form is signed at the end of the semester that you are enrolled in EDUC 100.
       Transfer students are to have their instructors sign the form or see the
       Associate Dean of College of Education FSU for signature. (Frampton 215)          Signature of EDUC 100 Instructor
      7/28/2012 c06f40ec-b617-4f4a-8a06-57433823f65e.xls
                                                                                                     Or Advisor