Application for Admission to the Teacher Certification Program

CWU ID: ______

Name ______Last First Middle Maiden

E-Mail Address______Social Security Number ______

Birth date______Female_____ Male_____ Year in College ___FR ___SO ___JR ___SR ___GR

Eth. Origin _____Asian _____Black _____Hispanic _____Native American _____Caucasian _____Other

Preferred Mailing Address______Street City State Zip

PHONE #s: Daytime ( )______Cellular ( )______Evening ( )______

What teacher certification program are you pursuing (please fill in either section A or B): A. CERTIFICATION ONLY: (If you already have a 4-year degree and are just obtaining certification) ENDORSEMENT AREAS:______

B. DEGREE AND CERTIFICATION: (If you are pursuing a 4-year degree): Major______Minor______

List all colleges attended (including CWU) and dates of attendance (unofficial transcripts must be included with your application): ______

Circle the CWU campus you plan to attend: Ellensburg – Yakima – Des Moines – Wenatchee – Pierce – Lynnwood (If you are planning on attending one of the university center programs (i.e., Des Moines, Wenatchee, etc.), please contact the center for the address in which to mail the application material).

If you did not score high enough on the SAT or ACT to satisfy the Basic Skills requirement (Reading, Writing, and Math), what date did you or do you plan to take the WEST-B? ______

SUBMIT THE FOLLOWING ITEMS WITH THIS APPLICATION:

__ Character and Fitness Supplement __ Transcripts from all colleges attended, except for CWU. These are independent of those sent for university application purposes.

NOTE: Current WSP and FBI fingerprint clearance will be required in order to remain enrolled in courses requiring any type of field experience or working with P-12th grade children. Clearance must be valid through the entire experience and/or quarter. Clearance will be monitored through the Teacher Certification Office.

I UNDERSTAND THAT I MUST HAVE A MINIMUM 3.0 GPA FOR THE LAST 45 GRADED QUARTER CREDITS OR OVERALL CWU/TRANSFER CUMULATIVE TO BE FULLY ADMITTED AND BE ALLOWED TO STUDENT TEACH, GRADUATE, AND BE CERTIFIED.

Applicant Signature______Date______

Return application packet to the following address: CWU Certification Office 400 E. University Way Ellensburg, WA 98926-7414