Application for Admission to the Educational Studies Division by CJhb7c3

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                                                 School of Education
                       Field Experience Application – Teacher Education Certification Program


Name:                                                                                                Date:
Telephone:                                                                                  Cell Phone:
Local Address:
Home Address:
Email address:
Academic Major:                                                                       Education Advisor:                                                               _
Academic Minor:                                                                             Minor Advisor:                                                             _
Are there any special circumstances that need to be considered relative to your placement? (transportation,
commuter, etc._____________________________________________________________________________________
________________________________________________________________________________________________
NOTE: Due to the limited availability of placements, the student is advised that he/she may have to travel outside of their hometown. If the student cannot commit to a placement
outside of Fond du Lac, he/she may have to defer the field experience until the next semester.
      Applicants for Field Experience will be required to complete a Background Verification Form and undergo
                                    A Criminal History Check by the Wisconsin Crime Information Bureau.


Signature___________________________________________________
Return this form to the Support Specialist in room T308, or mail to:
Marian University, 45 S. National Avenue Box 42, Attn: Teacher Education, Fond du Lac, WI 54935



                                                      FOR SCHOOL OF EDUCATION USE ONLY

Current GPA:                Total Credits Earned:
         1. A minimum cumulative GPA upon completion of the following minimum number of credits:
             2.50 GPA on a minimum of 30 credits         2.85 GPA on a minimum of 75 credits
             2.60 GPA on a minimum of 40 credits         3.00 GPA on a minimum of 90 credits
             2.75 GPA on a minimum of 60 credits

            2.    Praxis I Basic skills test –Passed or Not Passed
                           Reading                           Math                   Writing
                  Entrance/Continuation Requirements:
                  All segments of the Praxis I must be passed before Field Experience in the Teacher Education Certification Program

            3.    Submission of required health records (Field Experience TCH 601 ONLY)

            4.    Submission of Background Verification Form

INITIAL FIELD EXPERIENCE PROGRAM ADMISSION:
           Date Admitted to the Field Experience Program
           Date Denied Admission to Field Experience Program and Education Courses (Teacher Education Program)
Describe:

\\mcfs1\users\SOE\_UG\Field Experience\Application to Field Experience ATC.docx

								
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