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Alternative Teacher Certification Program Application Packet
(Use the following checklist to ensure you have completed all application requirements)
You will only be considered for a screening interview with the Admissions Committee when you have submitted all items. To help make sure no items are misplaced, it is best to submit the items all at the same time so your interview can be scheduled. It is the applicant’s responsibility to confirm all items have been received and to contact the office to set up interview date/time.
□ Completed Application
□ Official (sealed) college transcript(s) from all school attended (excluding high school)
□ $40 application fee receipt paid online or form completed by Business Office in Registration.
□ Essay “Why I Want to Be a Teacher”
□ Resume demonstrating knowledge in content area.
□ 3 professional recommendations in a sealed envelope
□ Basic Skills Test scores for one of the following assessments taken within 5 years.
COMPASS: Reading 81+, Writing 59+, Math (Algebra) 39+, Essay 5+
ACCUPLACER: Reading Comprehension 81+, Sentence Skills 80+, Elementary Algebra 63+, Essay 6+
ACT: Composite score of 23 with a minimum of 19 on the English test and/or mathematics test
SAT: combined verbal and mathematics score of 1,070 with a minimum of 500 on the verbal test and/or the mathematics test.
□ English Proficiency Test: Compass/ESL test scores:
o Reading 80+, Grammar 84+, Listening 82+ and a total score of 244+.
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|Lone Star College-CyFair | |
|Alternative Teacher Certification Program | |
| | |
|9191 Barker Cypress Rd. |Email: |
|Mod. 1 #110 |Cy-Fair.TCP@lonestar.edu |
|Cypress, Texas 77433 |281-290-3957 |
| |FAX: 281-290-5932 |
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|Name (circle one) Mr. Mrs. Ms. Miss. |
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|Last First Middle |
|Must be as it appears on driver license |
|Maiden Name |
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|Address : |
| Street Number Apt. number |
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| City State Zip |
|Home Phone Number Alternative Phone Number |
|Driver’s License Number State Expiration Date |
|Email Address |
|Social Security Number |
| |
|Date of Birth (mm dd yyyy) Gender M F |
|Ethnicity: |
|Hispanic/Latino of any race yes no |
|Race: Check all that apply |
|American Indian or Alaska Native |
|Asian |
|Black or African American |
|Native Hawaiian or Other Pacific Islander |
|White |
|Two or more races |
Bachelor’s Degree conferred ________/________/_________ by _________________________________________
Month Day Year College/University
Located in _________________________________________ Major _____________________ GPA ____________
|Additional Degrees |College/University |City/State |Date Conferred |
| | | | |
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Have you served in the military?
( No ( Yes Which branch? ______________________________ When? ________________________
Have you applied to a teacher certification program before?
( No ( Yes When? ___________________ Where? _________________________
Have you ever worked in a public school under a deficiency plan or emergency permit?
( No ( Yes When? _____________________ Where? _______________________
Have you ever taught in the Texas public schools? ( No ( Yes
If yes, where? ____________________________________________________________
Work Experience: In the space below, please list positions you have held previously. You may include any volunteer positions you feel may be relevant to this application. Please put an “*” beside any employment or volunteer position where you had an opportunity to work with children. If more space is needed, please attach another sheet of paper or include in your resume.
|School District or Firm Name |Your Position |Address |Area Code/ |Immediate |Full or Part |Dates Employed |
| | |City/State/Zip |Telephone |Supervisor |Time | |
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Have you ever been convicted of a felony? ( No ( Yes
Are you a citizen of the USA? ( No ( Yes
Do you have Permanent Resident Status? ( No ( Yes (please provide us with a copy)
Is English your first language? ( No ( Yes
Other than English, what languages do you speak/write?
Language ______________________________________________ ( Speak ( Write
Language ______________________________________________ ( Speak ( Write
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LSC-CyFair Alternative Teacher Certification Program
Candidate Agreement
APPLICANT: Submit this signed agreement with your application packet.
1. I understand I must submit the non refundable application fee of $40 for my application to be reviewed by LSC-CyFair Alternative Teacher Certification Program.
2. I affirm statements by me in this application are true and accurate to the best of my knowledge. I understand any false statements, misrepresentations or omission made by me during the application process shall be grounds for refusal to be admitted to the program.
3. I agree to abide by the Lone Star College-CyFair testing and assessment requirements.
4. I understand that the State Board for Educator Certification (SBEC) will complete fingerprinting and a criminal background check before issuing a probationary teaching certificate.
5. I hereby authorize LSC-CyFair to investigate through whatever means deemed appropriate and facts resulting from the investigations to determine my suitability for acceptance into the program. I release LSC-CyFair Teacher Alternative Teacher Certification Program from any liability in connection with the investigation.
6. I understand that meeting the eligibility requirements does not guarantee me an interview or acceptance into the program and being interviewed does not guarantee me admission into the program.
7. I agree to abide by the policies, procedures, rules and regulations of the LSC-CyFair Teacher Alternative Certification Program.
8. I agree to pay for each course taken before the start date of each class in order to keep my place in the program. I understand that tuition and fees are subject to change and are non-refundable.
9. I understand that if accepted into the program I MUST take course work in the same semester or next semester. If you feel the cost of the course isn’t currently in your budget, then delay application until you are able to pay and attend the required course.
10. I hereby authorize LSC-CyFair Alternative Teacher Certification to release application information for interview screening and employment purpose to school districts.
11. By applying to and registering at LSC-CyFair I agree to abide by the Student Discipline Policy and Student Rights and Responsibilities regulations published in the Lone Star College System catalog and the Student Handbook.
I UNDERSTAND AND AGREE TO THE ABOVE ITEMS:
PRINT NAME: ______________________________ DATE: __________________________
SIGNATURE OF APPLICANT: ____________________________________________________
Certification Area Worksheet
Certification area based on transcript core courses: English, Math, Science, Social Studies, Speech. The following will help you evaluate your transcript(s) to see if you have enough hours.
PLEASE CIRCLE THE CERTIFICATION (CONTENT) YOU ARE INTERESTED IN
▪ EC-6 Generalist (39 semester hours)
▪ 4-8 Generalist (39 semester hours)
▪ 4-8 ESL Generalist (39 semester hours)
▪ 4-8 Math, Science, Social Studies, ELAR (24 sem hrs)
▪ 8-12 ELAR, Math, Science, Social Studies (24 semester hours)
▪ 8-12 Science Composite (36 semester hours in combination) (Bio, Chem, Phys, Earth Science, Phy Nat Science)
▪ 8-12 Social Studies Composite (36 semester hours in combination) (Hist, Govt, Econ, Pol Sci)
▪ ESL Supplemental 12 semester hours English & 18 hours in Math, Social Studies, Natural Science and Speech
▪ EC-12 Special Ed Supplemental – (39 sem hrs + 3 hours Psych on transcript)
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8-12 English Language Arts & Reading 8-12 Math EC-12 Music
8-12 Physical Science 8-12 History EC-12 Physical Edu
8-12 Speech EC-12 Health EC-12 Art 8-12 Life Science EC-12 Theatre
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Complete the following essay by responding to the following question in complete sentences using proper grammar and punctuation; use an additional page if necessary.
PROOF THOROUGHLY.
A Word document may be attached, if you prefer.
Why do you want to be a teacher?
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Alternative Teacher Certification Program
Recommendation Form
Professional Recommendation For: ________________________________________________
(Applicant’s Name)
The above applicant has selected you as a source of reference. We would appreciate your comments as to the applicant’s qualifications. NOTE: When this reference is received in the Alternative Teacher Certification Program office, it is held strictly confidential and not revealed to the above named applicant.
|Check appropriate column for each item |Superior |Above Average |Average |Fair |Poor |Do Not Know |
|below | | | | | | |
|Ability to present ideas | | | | | | |
|Work Habits | | | | | | |
|Professional attitude | | | | | | |
|Rapport with peers | | | | | | |
|Resourcefulness | | | | | | |
|Reliability | | | | | | |
|Cooperation | | | | | | |
|Professional appearance | | | | | | |
|Enthusiasm | | | | | | |
|Other: | | | | | | |
Additional Comments:________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Alternative Teacher Certification Program
Recommendation Form
Professional Recommendation For: ________________________________________________
(Applicant’s Name)
The above applicant has selected you as a source of reference. We would appreciate your comments as to the applicant’s qualifications. NOTE: When this reference is received in the Alternative Teacher Certification Program office, it is held strictly confidential and not revealed to the above named applicant.
|Check appropriate column for each item |Superior |Above Average |Average |Fair |Poor |Do Not Know |
|below | | | | | | |
|Ability to present ideas | | | | | | |
|Work Habits | | | | | | |
|Professional attitude | | | | | | |
|Rapport with peers | | | | | | |
|Resourcefulness | | | | | | |
|Reliability | | | | | | |
|Cooperation | | | | | | |
|Professional appearance | | | | | | |
|Enthusiasm | | | | | | |
|Other: | | | | | | |
Additional Comments:________________________________________________________________ ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Alternative Teacher Certification Program
Recommendation Form
Professional Recommendation For: ________________________________________________
(Applicant’s Name)
The above applicant has selected you as a source of reference. We would appreciate your comments as to the applicant’s qualifications. NOTE: When this reference is received in the Alternative Teacher Certification Program office, it is held strictly confidential and not revealed to the above named applicant.
|Check appropriate column for each item |Superior |Above Average |Average |Fair |Poor |Do Not Know |
|below | | | | | | |
|Ability to present ideas | | | | | | |
|Work Habits | | | | | | |
|Professional attitude | | | | | | |
|Rapport with peers | | | | | | |
|Resourcefulness | | | | | | |
|Reliability | | | | | | |
|Cooperation | | | | | | |
|Professional appearance | | | | | | |
|Enthusiasm | | | | | | |
|Other: | | | | | | |
Additional Comments:________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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Alternative Teacher Certification Program
9191 Barker Cypress Rd. Mod. 1 #110 / Cypress, Texas 77433-1383
(281) 290-3957 / FAX 281-290-5932
NOTE: DO NOT SEND CASH OR CHECK TO THE ATCP OFFICE,
ALL FEES SHOULD BE HANDLED BY THE BUSINESS OFFICE
Non-AR Payment Worksheet
Take this form to the Business Office payment counter Learning Commons (one stop Registration Center).
Bring a copy of the completed receipt to
Alternative Teacher Certification in Mod. 1 #110 with your application.
Candidate Name: _______________________________________________
LSCS student-ID or Social Security # ____________________
Alternative Teacher Certification Application Fee
400265002100 $40.00
Business Office Use Only: THIS FORM IS TO BE KEPT ON FILE.
Date: Receipt Number:
Session Number: Amount Paid:
-----------------------
Reference Contact Information
Date: _____________
Name _______________________________________
Position _____________________________________
Firm ________________________________________
Telephone ___________________________________
Address ______________________________________
City/State/Zip ________________________________
Signature ____________________________________
Please return this
recommendation in a sealed envelope to the candidate that is asking you for the reference
Reference Contact Information
Date: _____________
Name _______________________________________
Position _____________________________________
Firm ________________________________________
Telephone ___________________________________
Address ______________________________________
City/State/Zip ________________________________
Signature ____________________________________
Please return this
recommendation in a sealed envelope to the candidate that is asking you for the reference
Reference Contact Information
Date: _____________
Name _______________________________________
Position _____________________________________
Firm ________________________________________
Telephone ___________________________________
Address ______________________________________
City/State/Zip ________________________________
Signature ____________________________________
Please return this
recommendation in a sealed envelope to the candidate that is asking you for the reference
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