University of Minnesota Duluth
College of Education & Human Service Professions
Department of Education
150 EduD, 412 Library Drive, Duluth, MN 55812
Application for Admission
ADMINISTRATIVE LICENSURE PROGRAMS
Date of Application
Program(s): Principal Superintendent
Desired Term of Entry Fall Spring Summer Year
Name (Last, First, MI)
Business City/State Zip
Cell Phone Fax
U of M ID# Soc Sec #
Date of Birth
Country of citizenship: United States Other, specify:
State in which you claim legal residency
How long have you lived in that state? (years, months)
University you received your undergrad degree from:
Current licenses held License(s) desired
Certificate in Educational Administration with licensure endorsement
Non-degree/Non-certificate with licensure endorsement available for students already licensed
as an educational administrator in Minnesota or another state, or other cases with advisor approval.
Current school district of School Name Grades
Total number of years of classroom teaching experience:
District name and state
Area of teaching
Have you ever served as a K- License Area: Approximate number of hours
12 administrator in the past? or years:
File Folder #:
Educational information (official transcripts must be received prior to submission to the state)
Number of credit’s beyond the Highest degree completed Institution
Area of study Year completed Cumulative GPA of highest
Human Relations Requirement: if currently licensed as a teacher or school administrator in MN, the
license is verification of this requirement. If not currently licensed, please supply data requested.
Currently licensed OR Institution and date of completion of course (must be verified by official
Additional Application Requirements
Essay: Please compose and attach a 1-2 page, double-spaced essay responding to:
1. Either to the following statement from Ira Shor:
“Empowering Education invited students to question school and society to consider some
alternative and to imagine others, and to reject the inequality whose roots lie in the economic
system. Society would be very different if education were critical and democratic.”
Shor, Empowering Education. P.198.
2. From your perspective, what is the role of school administrators in transforming schools
and society and engaging schools in social change.
Transcripts: Please provide transcripts verifying any work completed after you received your
initial bachelor’s degree. The transcripts must be official (mailed directly from the institution to
the address listed below).
Recommendation: Please include two letters of recommendation that can speak to your abilities
to address the competencies of the EdAd program. These can be emailed, faxed or mailed to
Karen Mehle at the address below.
Fee: Please include a check payable to UMD for $30.
Should you enroll in the program, then become inactive for two consecutive semesters, you will
need to reapply to the program and pay a program fee equal to the difference in the current
program fee that is place when you reapply. In addition, you will be held to the licensing
requirements in place at the time of your reapplication.
I do not have my own hospitalization provider and would like to have student health insurance
from the University.
I have my own provider. Name of company
Policy #: _____________________ Company Phone Number:
I certify that the information provided on this form is complete and accurate.
Signature of Applicant / Date
Send completed application, including essay and program fee to:
Department of Education
Attn: Karen Mehle
412 Library Drive
Duluth, MN 55812-3029
Questions? Call Karen Mehle at 218-726-6525, Fax 218-726-7008 or
The information requested below is voluntary for reporting and research and will be used for summary
reports required by federal and state laws and regulations and to support institutional affirmative action
efforts. It will not be used as a basis for admission or in a discriminatory manner. You will not be
subjected to adverse treatment if you do not provide any of the requested information.
Gender (check one) Female Male
Predominant ethnic background (check one)
African-American (non-Hispanic origin) Chicano
American Indian or Alaskan native Other Hispanic
Asian or Pacific Islander White, non-Hispanic