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1243965-758190006318885155575Office Use:GPA ______________Rec ______________Trans _____________Adm Date __________00Office Use:GPA ______________Rec ______________Trans _____________Adm Date __________5th Year Program: Elementary EducationApplication for AdmissionApplicant InformationFull Name: FORMTEXT ????? FORMTEXT ????? FORMTEXT ???Date: FORMTEXT ?????LastFirstM.I.Address: FORMTEXT ????? FORMTEXT ?????Street AddressCounty FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????CityStateZIP CodePhone:Home ( FORMTEXT ?????) FORMTEXT ?????Work ( FORMTEXT ?????) FORMTEXT ?????Cell ( FORMTEXT ?????) FORMTEXT ?????Student ID: FORMTEXT ?????Email: FORMTEXT ?????Date of Birth: FORMTEXT ?????5th Year Concentration:*Choose oneLiteracy FORMTEXT ?????STEM FORMTEXT ?????Content FORMTEXT ?????Ethnicity: FORMTEXT ????? (Black, Caucasian, Hispanic, Native American, Other)Are you a citizen of the United States?Yes FORMCHECKBOX No FORMCHECKBOX Are you a legal resident of NC?Yes FORMCHECKBOX No FORMCHECKBOX Gender:Female FORMCHECKBOX Male FORMCHECKBOX Have you ever been convicted of a felony?Yes FORMCHECKBOX No FORMCHECKBOX If yes, explain: FORMTEXT ?????Student OrganizationsPlease list all the HPU student organizations that you have been or are currently anization: FORMTEXT ?????Leadership Positions Held FORMTEXT ?????From: FORMTEXT ?????To: FORMTEXT ?????Comments: FORMTEXT ?????Organization: FORMTEXT ?????Leadership Positions Held FORMTEXT ?????From: FORMTEXT ?????To: FORMTEXT ????Comments: FORMTEXT ?????Organization: FORMTEXT ?????Leadership Positions Held FORMTEXT ?????From: FORMTEXT ?????To: FORMTEXT ?????Comments: FORMTEXT ?????Organization: FORMTEXT ?????Leadership Positions Held FORMTEXT ?????From: FORMTEXT ?????To: FORMTEXT ?????Comments: FORMTEXT ?????Organization: FORMTEXT ?????Leadership Positions Held FORMTEXT ?????From: FORMTEXT ?????To: FORMTEXT ?????Comments: FORMTEXT ?????Organization: FORMTEXT ?????Leadership Positions Held FORMTEXT ?????From: FORMTEXT ?????To: FORMTEXT ?????Comments: FORMTEXT ?????RecommendationPlease list the individuals who will be completing your recommendation. The recommendation form that should be used can be found at the end of this application. Please print and provide a copy to each individual.Elementary Education Majors: Two recommendation letters must be submitted on the forms attached. One should be from an Elementary Education professor and one can be from an Academic Advisor, a professor outside of education, pastor, current employer, etc. Special Education Majors: Two recommendation letters must be submitted on the forms attached. One should be from a Special Education professor and one from an education faculty member outside of special education.*Note: Please be sure to complete the top portion of the recommendation form before providing to your reference.Full Name: FORMTEXT ?????Relationship: FORMTEXT ?????Full Name: FORMTEXT ?????Relationship: FORMTEXT ?????Previous EmploymentList part-time or full-time work experiences in chronological order beginning with most pany: FORMTEXT ?????City/State: FORMTEXT ?????Position & Responsibilities: FORMTEXT ?????From: FORMTEXT ?????To: FORMTEXT ?????Comments: FORMTEXT ?????Company: FORMTEXT ?????City/State: FORMTEXT ?????Position & Responsibilities: FORMTEXT ?????From: FORMTEXT ?????To: FORMTEXT ?????Comments: FORMTEXT ?????Company: FORMTEXT ?????City/State: FORMTEXT ?????Position & Responsibilities: FORMTEXT ?????From: FORMTEXT ?????To: FORMTEXT ?????Comments: FORMTEXT ?????Disclaimer and SignatureI certify that the statements made in this application are true and accurate:Signature:Date:HIGH POINT UNIVERSITYSCHOOL OF EDUCATION5th Year Program: Elementary EducationApplication for AdmissionESSAYEssay Prompt for Elementary Education Majors:As a future 21st Century elementary teacher, what is your responsibility in helping to prepare students to be future-ready and globally-competitive?Essay Prompt for Special Education Majors:As a future 21st Century educator use your Special Education background and discuss your responsibility in helping to prepare students to be future-ready and globally competitive. FORMTEXT ?????HIGH POINT UNIVERSITYSCHOOL OF EDUCATION5th Year Program: Elementary EducationApplication for AdmissionConfidential Letter of RecommendationApplicants, please complete the top portion, including your signature. Please provide a stamped addressed envelope for your letter to be returned to High Point University._______________________________________ has applied to the 5th Year Program in the School of Education at High Point University to pursue a Master’s degree and has requested your letter of reference. Please answer the questions in as specific and candid a manner as possible. Your comments will be available only to those involved in the admission decision process. Your signature across the seal of the envelope ensures confidentiality. Please return, in the stamped envelope provided by the applicant to:High Point UniversitySchool of Education833 Montlieu AvenueHigh Point, NC 27262Applicant’s signature: I waive my right to see this letter of recommendation:______________________________________________ Date ____________________Name of individual completing this form: ________________________________________________Position and/or relationship to applicant: ________________________________________________How long have you known the applicant?Under what circumstances have you known the applicant?What do you consider to be the applicant’s most outstanding talents or characteristics?Are there any notable weaknesses that might hinder the candidate’s success in graduate studies? If so, please explain.In what ways have you observed the applicant demonstrate originality and independence in thinking?Please add any additional information that would be helpful for us in evaluating the candidate’s application.OutstandingVery GoodAverageBelow AveragePoorNot ObservedIntellectual AbilityLeadership PotentialMaturity LevelDispositionAbility to work with othersOrganization and time managementAbility to work independentlyAbility to communicate orallyAbility to communicate in writing____strongly recommend _____recommend____recommend with reservations _____do not recommend_____________________________________________ ________________________ (Signature) (Date) ................
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