ࡱ> a Bbjbj** q-H=bH=b:(((((tDdb%DDDDDN4I$$$$$$$$')%(eee%((DD% e (D(D$ e$ V=$@$Dpfo}$ $2%0b%$ N*] RN*$N*($8ee eeeee%% eeeb%eeeeN*eeeeeeeeeB :  APPLICATION FOR CREDENTIAL PROGRAM ADMISSION Undergraduate Candidates Education Department Pacific Union College Pacific Union College Education Department Teacher Education Program Credential Office, Education Building One Angwin Avenue Angwin, CA 94508 Phone: 707-965-6643 Email: teachingcredentials@puc.edu Fax: 707-965-6645  UNDERGRADUATE CREDENTIAL PROGRAM APPLICATION California Preliminary Multiple Subject and Single Subject Credential Programs Seventh-day Adventist Basic Teaching Certificate Programs We welcome your application for admission to a PUC teacher education program. This is your guide to the admission process. If you have any questions, please contact the Credential Analyst in the Education Department Credential Office. PRIORITY APPLICATION CONSIDERATION Program applications received by May 31 for Fall Quarter start in methods course and field experience sequence will receive priority consideration. Applications received after this date will be considered in the order received. PROGRAM ADMISSION DEADLINES Program admission by the end of the sophomore year is highly recommended to ensure completion of program requirements in a timely manner. Admission by the end of the sophomore year is required for Adventist Mission Scholarship recipients. PREREQUISITES TO PROGRAM ADMISSION Completion of EDUC 101-Introduction to Teaching with C- or better Completion of EDUC 101L-Classroom Observations with B- or better OR Experience Waiver Minimum cumulative GPA of at least 2.75 Completion of at least one quarter of successful college level coursework Full passage of Basic Skills Test Issuance of a Certificate of Clearance by the California Commission on Teacher Credentialing Submission of a COMPLETE application for program admission (see below) Completion of Admissions Interview with Credential Analyst REQUIRED PROGRAM APPLICATION MATERIALS Only COMPLETE applications containing ALL required materials will be accepted and reviewed for program admission. Exception: Freshman Adventist Mission Scholarship Recipients are required to submit a partial application at the end of their freshman year (Application form, Advisor Interview form). All program application materials are to be submitted together at the time of the Admissions Interview. A COMPLETE application includes the following items. Please read these instructions carefully. Application Form: Please print legibly. Make sure application form is complete and signed. The form is contained in this packet. ( ) Completed Advisor Interview: Make an appointment with your Education Advisor to discuss the credential program and make plans for the future. Have your advisor complete the attached Advisor Interview form, sign it, and return it to you. ( ) Completed Personal Statement: Write a personal statement which responds to the questions below. This statement should be at least one page, but no more than four pages, in length, typed. Why do you want to be a teacher? At what grade level would you like to teach and why? What personal traits and skills do you recognize in yourself that will contribute to your success as a teacher? What teaching or leadership experiences have you had working with children or adolescents? What are your personal attitudes and experiences with children or adults of diverse ethnic, cultural, or socio-economic backgrounds? ( ) Completed Recommendation: Obtain a professional recommendation supporting your program acceptance. The recommender should be someone who recognizes your potential for success as a teacher. Recommendations from friends or family members are not acceptable. Use the attached form and have the recommender send it directly to the Credential Office. ( ) Completed Basic Skills Requirement (BSR): Submit a copy of the official BSR score report you received from the test company. Undergraduate candidates must take and pass all portions of the California Educational Basic Skills Test (CBEST). A CBEST information packet available in the department brochure rack. ( ) Completed Certificate of Clearance: Submit a Certificate of Clearance issued by the California Commission on Teacher Credentialing. Instructions for obtaining a clearance are outlined in the LiveScan & Certificate of Clearance packet available in the department brochure rack. ( ) Completed Verification of SDA Church Membership: If you are a Seventh-day Adventist and wish to obtain an SDA Teaching Certificate along with a California credential, submit either a copy of your baptismal certificate or a letter from your home church verifying that you are a church member. ( ) Completed WHEN YOU HAVE GATHERED ALL REQUIRED APPLICATION MATERIALS, PLEASE CONTACT THE CREDENTIAL OFFICE TO SET AN APPOINTMENT FOR AN ADMISSIONS INTERVIEW. Pacific Union College Education Department APPLICATION FOR ADMISSION TO THE TEACHER CREDENTIAL PROGRAM  FULL LEGAL NAME ADDITIONAL NAMES THAT MAY APPEAR ON OFFICIAL RECORDS LOCAL ANGWIN MAILING ADDRESS, if a current PUC Student (DORM or PO Box/Street Address, City, State, ZIP) PERMANENT HOME MAILING ADDRESS (PO Box or Street Address, City, State, ZIP) LOCAL PHONE:CELL PHONE:HOME PHONE:PUC E-MAILOTHER E-MAILPUC ID:CLASS STATUS: FR SOJR SRDATE OF BIRTH:COUNTRY OF CITIZENSHIP:IF NOT A US CITIZEN, ARE YOU APERMANENT RESIDENT?YES NOOPTIONALGENDER: ( ) M ( ) FINFORMATIONMARITAL STATUS: ( ) Single ( ) MarriedFurnishing information forETHNIC BACKGROUND: ( ) American Indian or Alaska Native( ) Asian( ) Black or African Americanthis section is voluntary.( ) Hispanic/Latino of any race( ) Native Hawaiian or Other Pacific Islander( ) White ( ) Two or more racesAll data is strictly( ) Other__________________________confidential and will beRELIGIOUS PREFERENCE: ( ) Seventh-day Adventist( ) Other__________________________________used for statisticalpurposes only.CONTENT MAJORMAJOR:ADVISOR:EXPECTED GRADUATIONDATE:SCHOOLS ATTENDEDPlease list all colleges and universities attended. Submit transcripts for all school listed.COLLEGE/UNIVERSITYDATES ATTENDEDFOR SDADo you wish to obtain a Seventh-day Adventist Teaching Certificate:( ) YES( ) NOCANDIDATES ONLYAre you a baptized SDA church member? ( ) YES ( ) NO;Home church:____________________________(Membership in the Seventh-day Adventist Church is a prerequisite for earning a SDA teaching certificate.)How will you verify church membership with this application?( ) Copy of baptismal certificate( ) Letter from church pastorCRIMINAL RECORDDo you have any type of criminal record that will prevent you from being eligible for a credential?CLEARANCE( ) NO ( ) YES Please explain:All applicants for admission must submit a CTC-issued Certificate of Clearance verifying clearance.COMPLETION OFPlease identify the program admission prerequisites that you have completed:ADMISSION( ) EDUC 101-Introduction to Teaching, Quarter: __________Grade:__________PREREQUISITES( ) EDUC 101L-Classroom Observations, Quarter:__________Grade:__________OR ( ) Waiver for EDUC 101L based on equivalent experience( ) One full quarter of successful college coursework( ) Cumulative GPA of at least 2.75; Current GPA:________Quarter:_________( ) Issuance of a Certificate of Clearance by the CA Commission on Teacher Credentialing( ) Basic Skills: ( ) CBEST, ( ) SAT, ( ) ACT, ( ) Other_______________ DESIREDPlease identify the certification/credentials you wish to earn through PUCs program (check all that apply):CERTIFICATION( ) SDA Basic Elementary (1-8)( ) SDA Basic Secondary (9-12)( ) CA SB2042 Preliminary Multiple Subject (K-12, self-contained classroom)( ) CA SB2042 Preliminary Single Subject (K-12, departmentalized classroom in specific content area)SUBJECT MATTERPlease identify the subject matter you wish to teach:AREA( ) All subjects in a self-contained elementary classroom( ) Specific content area in middle or high school; Content area:___________________________SUBJECT MATTERAll candidates for admission to the program must meet one of the following criteria for subject matter competencyCOMPETENCYbefore they can be admitted to the credential program. Education Code 44227(a).VERIFICATION(NOTE: Education Department policy requires that the CSET exam, which demonstrates subject matter competency,be passed in full one quarter prior to the scheduled full-time student teaching experience. Student teaching will bedelayed if passing scores are not submitted according to this schedule.)( ) I am providing evidence of having PASSED IN FULL the appropriate CSET subject matter competency exams .( ) I am providing evidence of having ATTEMPTED the appropriate CSET subject matter exams.( ) I am providing evidence of REGISTRATION for the next scheduled CSET examination.( ) I am providing evidence that I have PLANNED with my Education Advisor when I will take the CSET exam.(This occurs as part of the Advisor Interview. See Advisor Interview form.)APLICANTI certify that I have carefully considered each question and that my statements are true and complete to the best of mySIGNATUREknowledge. I understand that misrepresentation in any statement may be considered sufficient reason for refusal ofadmission or disqualification. I have submitted with this application all required supporting documents.SIGNATURE________________________________________________ Date_____________________ OFFICE USE ONLY: ( ) Regular Admission ( ) Provisional Admission ( ) Admission Denied/Reason___________________________ Date: _______________________ Advisor:________ Pacific Union College Education Department APPLICATION FOR ADMISSION TO THE TEACHER CREDENTIAL PROGRAM RECOMMENDATION FORM NAME OF APPLICANT______________________________________________ Date__________________ INSTRUCTIONS: The above-named individual has expressed an interest in becoming a teacher and is making application to the teacher education program at Pacific Union College. Please rate the applicant in the areas listed below. Your rating and comments are confidential. CHARACTERISTICSNot ObservedMarginalAverageSuperiorAbility to relate to childrenLeadership skills & ability to take charge of a groupOrganizational skillsInitiative, self-motivation, and follow-throughInterpersonal relationshipsAbility to communicateCourtesy and concern for othersDependabilityAbility to cope with stressHealthJudgment and maturityPersonal appearance and neatnessDemonstrates sensitivity and tolerance towards individuals from diverse ethnic, cultural and socio-economic backgrounds How well do you know the applicant? ( ) little ( ) average ( ) well ( ) very well What is your relationship to the applicant? ( ) teacher ( ) employer ( ) other_______________________ Have you observed this applicant involved with children? ( ) YES ( ) NO In what role did you observe them? Do you feel this applicants choice to be a teacher is a good one? ( ) YES ( ) NO Please explain your response by commenting on the applicants aptitude for the teaching profession from your perspective. Signature Print Name_________________________________________ Title or Position Phone______________________ Please return this form in the attached envelope to the Credential Analyst, Education Department, Pacific Union College, One Angwin Avenue, Angwin, CA 94508. Pacific Union College Education Department ADVISOR INTERVIEW APPLICATION FOR ADMISSION TO THE TEACHER CREDENTIAL PROGRAM INSTRUCTIONS TO ADVISORS: Please complete this Advisor Interview form with candidates applying for admission to the preliminary teacher credential program. Sign and date at the bottom and give the form to the candidate to submit to the Credential Office with their program application packet.CANDIDATE NAME YEAR IN SCHOOL: Freshman Sophomore Junior Senior Post-Baccalaureate PROGRAM FORMAT: Undergraduate program completed concurrent with degree Non-degree program completed post-baccalaureateDESIRED CERTIFICATION: SDA Basic Elementary SDA Basic Secondary CA SB2042 Preliminary Multiple Subject CA SB2042 Preliminary Single SubjectCREDENTIAL CONTENT AREA & DESIRED ENDORSEMENTS: Main Content area:__________________________ Other possible endorsement areas:________________________________________________ Bilingual Authorization? no yes, Language_______________ DEGREE & GRADUATION: Major:________________________________ Major Advisor:______________________________ Graduation Date:________________________ School:_____________________________________PROGRAM REQUIREMENTS & PLANNING: Review program requirements. Develop a written plan for completing coursework in proper sequence.BASIC SKILLS REQUIREMENT: Date candidate plans to meet the Basic Skills Requirement: ___________ Option chosen: CBEST CSET MS + CSET: Writing ACT SAT Out-of-state testCERTIFICATE OF CLEARANCE REQUIREMENT: Date when candidate will complete LiveScan and apply for Certificate of Clearance:____________APPLICATION FOR PROGRAM ADMISSION: Date when candidate will make application for program admission:_____________METHODS SEQUENCE: Quarter when candidate plans to enter methods sequence (dependent on program admission): Fall____ Winter____ Spring ____ (Single Subject candidates must: be a junior , have completed at least 50% of major, and have a major GPA of at least 2.75 before they will be admitted to EDUC 361 and their first lab)CSET REQUIREMENT: Date when candidate will take CSET: ____________ (CSET must be passed at least one quarter prior to student teaching; take well ahead of deadline) ADVENTIST MISSION SCHOLARSHIP: Candidate awarded scholarship? yes no (If no, encourage them to apply through the Credential Office.)Other information Credential Office NEEDS TO know: ADVISOR SIGNATURE: DATE:   "45NX    L M _ ` b     ( )  * +   ? ~q~~~qhAq>*CJOJPJQJhAq5>*CJOJPJQJjhAqCJOJPJQJUhAqCJOJPJQJhAqOJPJQJhAq5CJOJPJQJhAq5CJ7OJPJQJhAq5CJ8OJPJQJhAq5CJ_OJPJQJhAq5CJ`OJPJQJhAqCJOJPJQJ( !"45NOPQRSTUVWd2ld]^l`d d9d6$da$dd8WX    ) L M _ a b  $dpd]d^pa$dddd $ad]aa$dI $%d]%a$ $ad]aa$HOd ]^H`Od    ( )  * +    ?  & F @@d^@` & F @@d^@`d4ddd|d]|ddd1,d],d JLs[dgwjk`aQ_#$de*qr/+24µªª̪ªªªªª‚o%jhAq5>*CJOJPJQJUhAq5>*CJOJPJQJhAqCJOJPJQJhAq5CJOJPJQJhAq5OJPJQJhAq6>*OJPJQJhAqOJPJQJhAq5>*OJPJQJhAqCJOJPJQJhgSCJOJPJQJhgShAqCJOJPJQJ+ JlKLstfg~ & F d0d]d^`0dd]dd]d $d]a$ @@d^@` & F @@d^@` & F @@d^@`gdAqaBP & F Td]T^d & F $d^`$d8 & F 0d]^`0dd^ & F 0d]^`0dd^PQ ./d & F 0d]^`0 & F 0d^`0 & F 0d]^`0dd^d$ & F d0d]d^`0a$d/+34DEFWXht|}dxd^xdd d8xd^xdFdd2$da$|d]^|`4DFWX|}56CFRT`oz",@IZfp !   q s t иhAqCJOJPJQJhAqCJOJPJQJhAqCJOJPJQJhAqCJOJPJQJhAqOJPJQJhAq5CJOJPJQJH056CDEFRST`a Pd9$If^P dd9$If^d d$If xd9$If^xxd^xddxd^xabcdefghijklmnoz{|}~ Pd=$If^P xd=$If^xFf d$IfFf[ dd=$If^dFf Ff d$If dd=$If^d xd=$If^xFf d$IfFf dA$If PdA$If^P! 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