ADMINISTRATIVE LICENSURE APPLICATION



ADMINISTRATIVE LICENSURE APPLICATION

Educational Administration and Supervision (EDAS)

All persons seeking administrative licensure and receiving recommendation from the College of Education and Human Development must complete this application regarding their career goals and attest to being of good moral character. In order for our office to process your application and approve your admission to a licensure pattern, please complete the following four sections and return this form to the address on the reverse side.

SECTION I: DEMOGRAPHICS

NAME:

ADDRESS:

PHONE NO. (       )

(city) (state) (zip)

E-MAIL:

PLACE OF EMPLOYMENT:

POSITION:

ADDRESS:

PHONE NO. (       )

(city) (state) (zip)

STUDENT’S P.I.N. NUMBER:

(P.I.N. NUMBER = Personal Identification Number)

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Please check the appropriate statement:

_________ 1. I am not pursuing a graduate degree program, but I am seeking Ohio provisional administrative licensure as indicated on the reverse side.

_________ 2. In addition to pursuing a graduate degree program, I will also be seeking Ohio provisional administrative licensure.

(Signature)

(Date)

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Please indicate ethnicity. (BGSU is required by Federal Law to report this information for statistical purposes.)

A. _______ Caucasian/White E. Hispanic:

B. _______ African American/Black _______ Mexican American

C. _______ Asian American/Pacific Islander _______ Puerto Rican

D. _______ American Indian/Alaskan Native _______ Other Hispanic

F. _______ Other Ethnic Group

(Please Continue on Reverse Side)

SECTION II: CAREER OBJECTIVES

1, What degree(s) do you presently hold? Name of granting institution and year.

2. What teaching and/or administrative, e.g., principal, supervisor, etc. certification/licensure to you presently hold?

3. What licensure do you desire to pursue with this application? Please check appropriate area(s).

A. _______ Admin. Principal Grades Pre K - 6

B. _______ Admin. Principal Grades 4-9

C. _______ Admin. Principal Grades 5-12

D. _______ Superintendent

E. _______ Admin. Curriculum & Instruction and Professional Development

F. _______ Admin. Education Staff Personnel Administration

G. _______ Admin. Educational Research

H. _______ Admin. Pupil Services Administration

I. _______ Admin. School-Community Relations

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

SECTION III: REQUEST FOR UNOFFICIAL CERTIFICATION AUDIT

If your graduate coursework was completed at a university other than BGSU and you would like to know which classes might transfer for administrative licensure, please provide the following documentation for consideration:

1. An unofficial copy of your graduate transcript

2. Descriptions of any courses that you want considered

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

SECTION IV: GOOD MORAL CHARACTER STATEMENT

The Ohio Department of Education requires that all students admitted to Teacher Licensure Programs in Ohio be of Good Moral Character (see definition below).

Have you ever been convicted or have you pleaded guilty to any offense included in the definition of Good Moral Character?

_________ Yes _________ No

SIGNED DATE

Good Moral Character – A person shall be deemed to be of good moral character provided that said individual has not pleaded guilty to or been convicted of any FELONY, any violation of Section 2907.04 CORRUPTION OF A MINOR, or Section 2907.06 SEXUAL IMPOSITION, or Division (A) or (C) or Section 2907.07 IMPORTUNING of the Revised Code, any offense of violence, theft, offense, or drug offense that is not a minor misdemeanor, or substantively comparable ordinance of a municipal corporation or of another state.

An individual who has pleaded guilty to or has been convicted of any such offense may be considered for full admission into Teacher Licensure Programs by the College of Education and Human Development only if such individual:

1. has had the record of his or her conviction sealed pursuant to the provisions of Section 2953.32 of the Revised code;

2. is presently determined to be of good moral character; and

3. otherwise meets the admission requirements for full admission into Teacher Licensure Programs.

Note: Issuance of any new licensure by the Ohio Department of Education is contingent upon the applicant having a Fingerprint/Background Check.

Please return this signed form to: Dr. Eric Myers, Licensure Officer

School of Educational Foundations, Leadership and Policy

512 Education Bldg

College of Education and Human Development

Bowling Green State University

Bowling Green, OH 43403-0250

(419) 372-7366 Fax: (419) 372-8265

emyers@bgsu.edu

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