<p>State of Michigan Educational Technology Endorsement Application</p><p>Applicant's Name:</p><p>Address:</p><p>WSU Student ID (if a WSU student Contact information Phone Number: Email address:</p><p>Do you have a current State of Michigan  Yes Teaching Certificate?  No Level of current teaching certificate Subject of current teaching certificate Recommended for Initial Provisional Certificate by which college or university Bachelors degree granted by which college or university Masters degree granted by which college or university (if applicable)</p><p>Teaching Experience School and District Subject Grade Level Dates Taught From: To: From: To From: To From: To From: To</p><p>1. Which plan do you wish to pursue in the endorsement program? Educational Technology Endorsement Application Revised 4/7/2018</p><p> Path I. Classroom Teaching Emphasis  Path II. Technology Leadership Emphasis for Teachers & Other School Personnel</p><p>(for information on plans see endorsement web site at www.coe.wayne.edu/InstructionalTechnology/TechEndorsement/ )</p><p>2. Do you intend to complete a graduate degree or an Educational Specialist Certificate while pursuing this endorsement? </p><p> Yes In what area? ______ No </p><p>Signature of Applicant ______Date ______</p><p>Complete the following Plan of Work to indicate which courses you will take to meet the endorsement requirements and return this completed application to:</p><p>Wayne State University Educational Technology Endorsement Program 489 Education Building Detroit, MI 48202 Education Technology Endorsement (NP) Plan of Work Minimum of 18 credit hours required</p><p>NAME ______(last) (first) (middle/maiden)</p><p>ADDRESS ______MI______(number) (street) (city) (state) (zip code)</p><p>PHONE ______I.D. ______</p><p>Required Five Courses DEPT. & COURSE SEM./YR. COURSE TITLE CREDITS GRADE UNIVERSITY # Wayne I T 5110 Applications of Technology in Education Cr. 3 Producing Technology-Based Instructional I T 5120 Cr. 3 Wayne Materials</p><p>Wayne I T 6140 Designing Web Applications for the Classroom Cr. 3 Wayne I T 6230 Internet in the K-12 Classroom Cr. 4 Wayne I T 8140 Seminar for Advanced Technology Integration Cr. 3 Electives (Select One Course from the following and delete the others) Wayne IT 7210 Foundations of Distance Education Cr. 4 Web-based Courseware Development Wayne I T 7140 (Alternative to IT 6140 for students with more Cr. 4 advanced technology skills) Facilitating Online, Face to Face and Blended IT 7130 Cr. 3 Wayne Instruction</p><p>TOTAL HOURS _</p><p>Plan of Work for Educational Technology Endorsement submitted by ______Date ______( Student's Signature)</p><p>Plan of Work approved by ______Date _ _ (Advisor's Signature)</p>