Teacher Education Program
TEACHER
EDUCATION PROGRAM APPLICATION
Reminder: Admission to the College
is not synonymous with admission to the Teacher Education Program.
Name S.S. Number
Campus
Address Campus Phone
Home
Address Home Phone ( )
City/State/Zip
Code
Teacher Education Program Advisor
Colleges I have attended:
My
purpose is to earn a B.S.E. in
Early Childhood
Education (Birth-Grade 3)
Elementary Endorsement Yes
No
Early Childhood Special Education Yes
No
Elementary Education
(Grades 1-6)
Subject area concentration
Early Childhood Yes
No
Additional Information
CGPA
Professional
CGPA
Subject
Area
Convicted of a felony? Yes No
My
projected graduation/completion date:
I
understand that in order to enter, remain in, and exit from the HLG Teacher
Education Program, I must comply with all institutional and state procedures,
and exit procedures. My failure to
comply with any institutional requirement (including HLG student conduct
regulations) or state requirement could result in my being dropped from the
program, making me ineligible for certification recommendation.
signature date