Name (first, last) (maiden
114300-22860000Northwestern Oklahoma State UniversityTeacher Education ProgramALTERNATIVE CERTIFICATION WAIVERAUTHORIZATION TO ENROLL IN RESTRICTED COURSESPlease attach current transcript and a copy of your certificate. Send to the Director of Teacher Education 709 Oklahoma Blvd., Alva, OK 73717 (Fax 580-327-8431)** To be completed by the student**Name (first, last) (maiden) ___________________________________________________Phone #_______________________Address__________________________E-mail___________________________Advisor_______________________I am making a request to enroll in restricted course(s) and have not been admitted to the Teacher Education program.I am requesting to enroll in following restricted course(s) for the ___________Semester/Year:________________________________________________________________________________________________________________________This request is made to complete courses for the Oklahoma State Department of Education to complete the requirements of Alternative Certification. A copy of my transcript and certificate are attached.___________________________________________________SignatureDate******************************************************************TO BE COMPLETED BY THE DIRECTOR OF TEACHER EDUCATIONThe person named above (has) (has not) been authorized to enroll in the course(s) listed above.______________________________________________________ Director of Teacher Education Date ................
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