Instructions to apply to the Field Based Teacher Education Program: Complete this on-line application., print and submit the confirmation page, along with the required copies of the autobiography, 1 commitment contract, 1 current Degree Evaluation, checklist of requirements, and manila file folder (letter size). Return all items together Teacher Certification, Ed. North, Room 202, A&M COMMERCE, Commerce, TX 75429.

 
*SSN: - -
((Make sure to enter correct SSN#)
*Date of Birth: - -

*Gender:

*U.S Citizen?:
   
*CWID:


*Ethnicity: *Race 1: *Race 2: 

*First Name:
(The name you enter MUST exactly match the name on your driver's license/government issued ID)
*Last Name:
(Use proper capitalization)
Maiden:

*Address:
(Use proper capitalization)
*City:
(Use proper capitalization)
*State *Zip:

*Home Ph: ( )- - Work Ph: ( )- -

Cell Ph: ( )- - *Email:

Permanent Address: Phone:

Teaching Fields: 1st 2nd (if applicable)
(*For 4-8/8-12/Secondary/All-Level applicants only,i.e. P.E.,Sped,Math,etc.)

*Level:

*Type of Plan :



*Campus (indicate the campus where you are receiving instruction):

Basic Skills Reading: Basic Skills Math: Basic Skills Writing: Speech Class Grade:

NOTE: You must meet all Basic Skills requirements to be fully admitted to the Teacher Education Program.

___________________________________________________________________________________________________________________________
*Have you ever been convicted of a felony? If yes, please explain and give date of offense on separate sheet of paper and attach to application.

NOTE: Admission to the Field-Based Program requires a minimum grade of "C" in coursework, an overall GPA of 2.75, a minimum GPA of 2.75 in Teaching Field courses and in Pre-Internship courses. A grade of "C" or above in a speech class, satisfactory completion of Basic Skills Requirements, departmental approval, and a successful interview with the public school which results in an intern placement are also required.



Please select first and second school district choice. Sites may be eliminated based on the number of students/requests. There is no guarantee of a 1st choice placement.
*1st School District choice: *2nd School District choice:


                         


*Required Fields
Note: Upon submission of this application, a confirmation page will be available for printing.
Please print the confirmation page and submit with the required documents, as listed on previous webpage.