Application

Email (other than SVC) *

Gender *

Female Male

Are you a US Citizen? *

Yes No

Home Phone or Room Phone *

Campus or Off Campus Address (where you will live during student teaching) *

Line 1

Line 2

City

State

Zip Code

Country

Permanent Address *

Line 1

Line 2

City

State

Zip Code

Country

In case of an emergency, please contact: *

First

Last

Relationship to Emergency Contact *

Student Status (key):
Undergraduate - all students seeking a B.S. or B.A. degree with certification or minor in education
Graduate - all students seeking a M.S. degree with certification
Post-baccalaureate - all returning students with a degree seeking first-time teacher certification
Second certification - all returning students with a degree seeking an additional certification, but not a degree

Student Status *

Major (if returning student, BA, BS, or MS degree area) *

Minor *

Your Advisor *

Cumulative GPA (if returning student, ending GPA of last completed degree) *

GPA in major (if returning student, please enter GPA of all completed SVC courses) *

Emergency Contact Phone Number *

If post-baccalaureate, graduate, or second certification student, where did you receive your BA or BS degree? *

Undergraduate students must have 6 credits in Math (MA 102, 103, 104 etc. will count). Post-baccalaureate or graduate students should indicate any math course(s) Algebra or higher, if taken.

Course 1 in College Math: *

Course 2 in College Math: *

ED 100 Foundations of Education Grade: *

ED 101, 102, 103, 207 Field Experience I Grade *

ED 205 Strategies and Techniques Grade *

ED 206 Field II: Strategies Lab (STEP-UP) Grade *

Which tests have you taken? *

PAPA SAT/ACT Exemption SAT/ACT Exemption N/A - If not taken, post-baccalaureate, 2nd certifcation, or graduate student ONLY ETS Core

Test score for Reading *

Test score for Writing *

Test score for Math *

FBI Clearance Date *

Act 34 Criminal History Date *

Act 151 Child Abuse Date *

Act 126 - Child Abuse Recognition & Reporting Training *

Please list any FBI or Criminal Offenses *

TB Test Date *

Certification area you are seeking *

Certification area(s) you are seeking if more than one or if option was not listed above *

Name of the high school you attended *

List all school districts you have attended as a student (or your children attend) in Westmoreland County, PA. Also, list any school districts that employ family members or relatives. *

Select first choice *

Select second choice *

Select third choice *

Select fourth choice *

Do you agree to the statement above? *

Yes No

Additional Comments or Special circumstances *

Pre-Student Teaching Online Application

CONTACT the education department

﻿Pre-Student Teaching Online Application﻿

CONTACT the education department

Pre-Student Teaching Online Application