Texas A&M University-Commerce
PBTC Application
(Please submit a printed copy along with Transcripts & Fee)

This application is part of the interview process.
*Application Date: / / *Social Security Number: - -
*First Name  
*Last Name  Maiden Name
A&M Commerce: CWID  TEA ID#  
*Address:     *City 
*State                   *Zip   
*Home Phone - - Cell Phone - -
*Email          Texas Resident (resided 1 Yr / more)
*Date of Birth - - Gender 
*Ethnicity   *Race1
Certification Area
Are you aware that the TExES content exams must be taken prior to admission using the PACT registration route/option?  ( PACT Link)

Note: Passing scores on the content area TExES test is required prior to making application and admissions to the PBTC program.
*Level :
*Content Area :
*Status prior to teaching :
Highest Degree Institution
Date Degree Awarded  - - State Degree Awarded
*What is your degree major?
*Have you ever been convicted of a felony or offense involving moral turpitude (including, but not limited to theft, rape, murder, indecency with a minor, drug possession, etc…)? Have you ever received probation or deferred adjudication?    If YES, please fully explain on a separate sheet. ("Yes" may not result in denial of admission.)
*Have you ever been enrolled in a teacher certification program or been approved to take a test from another program?
If Yes, give dates   Program Name
Reason(s) for discontinuation
*Program staff may decide to contact professional references to inquire of their knowledge of your abilities, performance, and/or character. List three persons (recent former employers/supervisors) who have definite knowledge of your abilities, performance, and/or character. If you have had school experience, please include references from district supervisors.
City, Address, State, Zip
Business Phone & Home Phone
Title & Relationship
General Informational Question
*1. How did you learn about the program ?
*2. Do you currently have any teaching job prospects? If so, where?
*3. What is your previous work experience? Please include experience working with children (paid or volunteer).
*4. Are you interested in a clinical/student teaching placement rather than a paid internship or if unable to secure a paid internship?
Interview Questions
IMPORTANT: Please answer the following questions fully and completely. This section is part of our interview process for admissions as required by TEA (Texas Education Agency). Your responses will help us determine if you are cleared, denied or if further information or requirements are needed for admission to our PBTC program.
*1. Why do you want to teach rather than pursue your current career (or another career using your degree)?
*2. What strengths will you bring to the classroom?
*3. What challenges do you think you will face in the classroom?
*4. What do you think is important with regards to classroom management?
*5. What is the most important thing you want us to know when considering your admission to our program (and, ultimately, your placement in a classroom)?
Program Agreement
As the applicant, I hereby certify that:
• the information within this application is true and correct, as well as all supporting/attached documentation;
• this application and supporting/attached documentation are provided of my own free will;
• I authorize investigation for verification of all information related to my application;
• I authorize exchange or disclosure of all information within the admission and retention process among Texas A&M University-Commerce, other certification entities, local education agencies/school districts, charter schools, private schools, the State Board for Educator Certification, The Texas Education Agency, and/or other entities relating to teaching or working with children and/or participating or cooperating in teacher certification programs.


I understand that under the Family Educational Rights and Privacy Act of 1974 (“FERPA” 20 USC 123g; 34 CFR 99; commonly known as the “Buckley Amendment”) no disclosure of my records can be made without my written consent unless otherwise provided for in legal statutes and judicial decisions. I also understand that I may revoke this consent at any time (via written request to the educator preparation program) except to the extent that action has already been taken upon this release. Further, without such a release, I am unable to participate in any field-based experiences including 30 clock hours of observation, clinical teaching, student teaching, or internship.

NOTE: Texas A&M University-Commerce expressly discloses the following:
1.   As a provider of teacher education programs, Texas A&M-Commerce must ensure its students demonstrate adherence to the Code of Ethics and Standard Practices of Texas Educators, which requires the observance of federal and state law. An arrest, indictment, conviction and/or deferred adjudication may result in a student being dismissed from the program.
2.   While Texas A&M-Commerce does not perform criminal history background checks, Texas public schools are permitted by state law to conduct criminal history background checks on a person intended for hire or a person who has requested a volunteer position. As a participant in an internship in a Texas public school, you may be subject to a criminal history background check.
3.   While Texas A&M-Commerce does not perform criminal history background checks, The Texas State Board for Educator Certification requests information regarding any previous arrest, indictment, conviction, and/or deferred adjudication. When applying for state certification, you will be subject to a criminal history background check by the State Board for Educator Certification. An applicant with a criminal history may be denied certification.
As the applicant, I understand that:
• false or misleading information in this application or supporting/attached documentation may result in rejection of my application or dismissal from the program should I be admitted;
• this application is NOT an employment contract;
• this application does NOT constitute acceptance into A&M-Commerce’s Alternative Certification Program;
• meeting eligibility requirements does not guarantee an interview or acceptance into A&M-Commerce’s Alternative Certification Program;
• acceptance by A&M-Commerce’s Alternative Certification Program does NOT constitute employment, nor does such acceptance entitle me to employment;
• I am responsible for gaining employment in the area in which I am accepted to pursue certification, but employment does not guarantee acceptance into internship;
• A&M-Commerce will not admit applicants who have not been successful in completing another certification program, or out-of-state and out-of-country certified teachers;
•A&M-Commerce’s Alternative Certification Program may limit the number of applicants admitted to the program;
•acceptance into A&M-Commerce’s Alternative Certification Program may be based solely on professional judgment; and
•I must continually comply with all program requirements and attend all courses/training or be subject to dismissal from A&M-Commerce’s Alternative Certification Program and all other teacher certification programs at A&M-Commerce.
•renewal of probationary certificate for subsequent years requires an additional internship fee of $250/each semester of support.
The following general information is for admission and retention into our Alternative Certification (AC) Program.
I agree to:
• Bachelor’s degree or higher from an accredited institute.
• An overall Content GPA of 2.75 or higher
• Professional development area course work GPA of 3.0 or higher ( Maximum of one "C" )
• No grade lower then a “C” in all required certification course work.
• Meet Basic Skills requirements.
• Enroll in required course work during the required semester as outlined on certification plan.
• Apply to the graduate school prior to enrolling in course work.
• Meet the NCLB “highly qualified” definition prior to placement in classroom (internship)
• Complete content area test during the first year.
• 30 hours of observation in an EC-12 academic setting.

State Board for Educator Certification
Texas Educators' Code of Ethics

Texas Administrative code §247.2
Statement of Affirmation

I affirm that I will comply with standard practices and ethical conduct toward students, professional colleagues, school officials, parents, and members of community and shall safeguard academic freedom, as set forth by the Texas Administrative Code §247.2. As a Texas educator, in maintaining the dignity of the profession, I shall respect and obey the law, demonstrate personal integrity, and exemplify honesty. In exemplifying ethical relations with colleagues, I shall extend just and equitable treatment to all members of the profession. In accepting a position of public trust, I shall measure success by the progress of each student toward realization of his or her potential as an effective citizen. In fulfilling responsibilities in the community, I shall cooperate with parents and others to improve the public schools of the community.

I hereby affirm that I have read and thoroughly understand the Texas Educators' Code of Ethics TAC 247.2, and shall abide by all enforceable standards of this rule.

Signature:____________________________ Date:____________________