Acceptance to the Teacher Education Program

ACCEPTANCE TO THE TEACHER EDUCATION PROGRAM

Last Name First Name Initial Birthday (xx/xx/xx) SSN (xxx-xx-xxxx)

Requirements for Acceptance into the Teacher Education Program

1. A minimum of 2.50 cumulative G.P.A.

2. A total minimum of 2.50 GPA in University Seminar, College Writing and Quantitative Reasoning (Core) with no grade lower than a ‘C’ (a grade of ‘C-’ or lower is not acceptable).

3. A record free of, “conviction of, entry of a guilty verdict, a plea of guilty, or a plea of no contest to a criminal offense involving moral turpitude in this state or any other state or country,” (Montana Annotated Code, Sec. 20- 4-110). In order to meet the requirement for question #3 (above), you need to answer the following questions: a. Have you ever been convicted of a crime more serious than a minor traffic violation? This disclosure must be made irrespective of whether the record was sealed or expunged, you served a sentence and had your civil rights restored, the sentence was deferred or suspended, or the charge was dismissed after conviction. Yes No If your answer to the above question is a “Yes”, explain fully below, specifying the nature of the offense(s), the date(s) it/them occurred, the name and location of the court (s), and the sentence(s) imposed. This disclosure must be made irrespective of whether you served a sentence and had your civil rights restored. Use additional pages if necessary.

b. Are you currently on probation, deferred prosecution, suspended sentence? Yes No If your answer to the above question is “Yes”, explain the circumstances and include the restrictions imposed by the courts. Use additional pages if necessary.

Schools will require a criminal records check before placement in public schools. MSU will receive your complete criminal record before placing students.

I hereby certify that the above information is true and correct, and I understand that any misrepresentations on this application may be grounds for denial of the application. By signing below, I acknowledge that all the information is accurate, and I give the Montana State University Education Department permission to verify any information provided.

______Signature Date Catalog: 2004-2006 Art Broadfield K-12 Montana State University K-12 Teacher Education Preparation Program

ID: Name: Date: Social Security # Last Name First Name Initial m/d/yr

Local Address: Phone: Street City State Zip Degree: College Degree Completed College Degree Sought Academic Courses Substitution Courses Subjec # Course Title CR GR Subject # Course Title CR GR t ART 110 2-D Fundamentals 3 ART 111 3-D Fundamentals 3 ART 202IA Ancient Medieval Art 3 ART 203IA Renaissance Modern Art 3 ART 238RA Representational Drawing 4 MTA 103RA Understanding Photo 3 ART 205 Painting 4 ART 206 Metalsmithing 4 ART 207 Sculpture 4 ART 208RA Ceramics 4 ART 209 Printmaking 4 ART 338 Advanced Drawing 5 Take One of the Following: ART 315 Advanced Ceramics 5 ART 325 Advanced Metalsmithing 5 ART 327 Printmaking-Lithography 5 ART 333 Advanced Sculpture 5 ART 344 Printmaking-Serigraphy 5 ART 350 Advanced Painting 5 ART 338 Advanced Drawing 5 ART 348 Advanced Intaglio Printmaking 3 ART 341 Advanced Relief Pt 5 Take Two of the Following: ART 302 Asian Art 3 ART 309 Baroque Art in Italy 3 ART 310 Baroque Art in Europe 3 ART 312 History of Decorative Art 3 ART 318 19th Century Art 3 ART 340 Ancient Art 3 ART 404 History of Printmaking 3 ART 418 Beginnings of Modern Art 3 ART 419 20th Century Art 3 ART 421 Women Artists 3 ART 425 Field Studies 2-5 ART 436 Late Gothic Painting 3 ART 440 Art & Revolution 1750-1800 3 ART 442 Medieval Art 3 ART 446 Early Renaissance Art 3 ART 448 High Renaissance & Mannerism 3 ART 405 Arts of Africa 3 ART 407 Islamic Art & Architecture 3

Academic Courses Substitution Courses Subject # Course Title CR Grade Subject # Course Title CR Grade

Take One of the Following: HDCF 150IS Lifespan Human Development 3 HDCF 160 Hum Dev: Conception to Adol 3 Secondary Professional Preparation EDCI 102 In-School Experience 1 EDCI 209 Ed Psych & Adolescent Dev 3 EDCI 320 Found of Instructional Comp 2 EDCI 360 Foundations of Assessment 2 HDHL 106 Drug/Health Issues for Educ 1 EDSD 363 Multicultural Education 1 HDCF 356 Exceptional Needs (0-21) 3 EDSD 453 Methods of Teaching Art 3 EDEL 332 Teaching Art 3 EDSD 301 Paraprofessional Experience 1 EDSD 410 Student Teaching 10-12 EDSD 413C Professional Issues 2

MATH ENGL 121 College Writing I 3 W COM* 110U Intro to Public Communication 3 S *May take approved courses with the letters US for University Seminar Core.

For office use only: First Aid with CPR Paraprofessional Experience Disclosure Statement

______Student's Signature Date

______Advisor’s Signature Date

______Certification Officer's Signature Date

For Use When Completing Student Teaching Application:

* Taking this course Spring Semester ** Taking this course Fall Semester or Summer Semester