Application for Level 2 - Adrian College



Adrian College Teacher Education Department

Admission to Level 2 - Teacher Education

Application Materials

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When finished, the application should be printed, signed (by you and your advisor), and submitted to the Teacher Education Department office. Your application cannot be considered until you have completed all steps and met all criteria described in this form.

Admission to Level 2 is a prerequisite for enrolling in TED330 or TED340, the introductory courses for the elementary and secondary professional education sequences. It is essential, therefore, to complete the application process during the semester prior to taking either TED330 or TED340.

Teacher Education Department, Adrian College

Application for ADMISSION TO LEVEL 2

Personal Data

Full Name:       Email:      

Social Security:       Birth Date:      

Local Address:       Local Phone:      

Current level: Current semester: Date of application:      

Program

✓ Certification level: Click the box indicating the program you are pursuing:

Elementary Secondary K12 in Music or Art Education

✓ Specialty studies: Before applying, you must declare your major and minor with the Registrar.

- Declaration forms are in the Registrar’s office or online at adrian.edu/campus_services/registrar.php

• Elementary (including those with K12 endorsement in PE, French or Spanish): Select (1) the Planned Elementary Minor, plus either (2) one endorsable major or (3) two endorsable minors

• Secondary (including the K12 endorsement in PE, French or Spanish): Declare either (1) an endorsable major and an endorsable minor or (2) one comprehensive group major

• K12 music/art: Declare the music or art education comprehensive group major

List the major(s)/minor(s) you have declared.

Major / Minor in      

Major / Minor in      

Major / Minor in      

Eligibility requirements

✓ Passing scores on all 3 sections of the MTTC Basic Skills Test

Have you passed all three sections of the Basic Skills test? Yes No

✓ Level 1 courses and field work (TED204 & TED205, plus TED200 field experiences)

▪ Final grades of C- or better , with a minimum of 2.7 GPA for all TED courses

▪ Positive fieldwork evaluations from cooperating teachers

- Evaluations are generally sent directly to the TED office by cooperating teachers. If an evaluation is not in your file, you may be asked to request an additional copy.

▪ If you are currently enrolled in a Level 1 course, the final grade and evaluation will be checked at the end of the semester. If requirements are not met at that time, you will not be able to take Level 2 courses next semester.

| |Semester |Grade |Field site(s) |

|TED204 Educational Psychology |      |      | |

| - TED200/201/202 Field work |      |      |

|TED205 Ed of Exceptional Children |      |      | |

| - TED203 Field work: special ed |      |      |

✓ Communication Skills

▪ List the semesters and final grades for these freshman-level required courses in speaking and writing.

▪ Grades lower than C- will be reviewed by the TED. A plan for strengthening weak areas may be required.

| |Semester |Grade |If course was accepted in transfer, list the college:|

|ENGL 101 Freshman Writing |      |      |      |

|COMM 102 Public Speaking |      |      |      |

Grade Point Averages:

✓ A 2.7 or higher cumulative GPA is required for admission and continuance in Level 2, 3 and 4.

▪ The TED will check your cumulative GPA at the end of each semester. If it falls below 2.7 at any time, you will not be eligible to take additional “professional sequence” courses until the minimum is once again achieved.

▪ If your GPA is currently below 2.7, you must write and attach a Petition to the TED Faculty requesting that the requirement be temporarily waived as you complete the current semester.

What is your current cumulative GPA?      

✓ In addition, a GPA of 2.5 or higher is required for each of your majors and minors.

▪ Specialty area GPAs are checked at three times: (1) as you apply for Level 2; (2) when you apply for the Professional Semester/Associate Teaching; and (3) when the Certification officer is preparing to submit your “Recommendation for Certification” to the MDE.

▪ Check specialty area GPAs with the “Degree audit” tool on My Adrian: adrian.edu/myadrian/index.php.

Do you meet the minimum GPA for each of your majors and minors? Yes No

Recommendations:

✓ Two positive recommendations from full- or half-time faculty members are required.

▪ One must be prepared by a faculty member of the department offering your major (or from a department offering one of your two endorsable minors). The second recommendation is to be prepared by any other faculty member who knows you well.

▪ A copy of the recommendation form is attached to this template. Print two copies, sign the waiver statement on each, and then submit them directly to your selected faculty members.

List the faculty members you have asked to complete your recommendations:

Specialization area instructor:      

Additional faculty member:      

Rule 101.1 Statement regarding Convictions

✓ You must submit a signed “Rule 101.1 Statement” reporting felonies and misdemeanors.

▪ A copy of the form is attached to this template to print, sign, and attach to your application.

Is the “Rule 101.1 Statement” signed and attached to this application? Yes No

I wish to apply for admission to Level 2 of the Teacher Education Department program indicated above. I have reviewed program and certification requirements in the Adrian College Catalog. I understand that I must continue to meet the listed requirements in order to continue enrolling in the professional education sequence courses.

Applicant Signature: ___________________________________ Date: ___________

Academic Advisor Signature:_________________________________ Date: ____________

State of Michigan Rule 101.1

Teaching Certificate Denial/Revocation Standards

Adrian College, Adrian, MI

Rule 101.1 of the Administrative Rules Governing the Certification of Michigan Teachers describes the State Board of Education’s authority to deny, suspend or revoke a teaching certificate. Reasons for doing so include conviction for certain misdemeanors and felonies. In addition, Michigan’s “School Safety” legislation (2005 PA 129-131 and 138) states that a person convicted of a ‘listed’ crime (those requiring a person to be listed on the ‘sex offender registry’) cannot be certified or work in any school. It also requires that, if you have any type of felony conviction, it must be reported to the school when you apply for a job, and that you can be hired only if the superintendent and school board both agree in writing to do so in spite of the conviction.

Fraud, misrepresentation, or concealment when applying for a certificate are also reasons that a certificate may be denied, suspended or revoked.

When Adrian College submits your “Recommendation for Certification” to the Michigan Dept of Education (MDE), if you have more than a single misdemeanor conviction, the certification officer is required to attach that information to the Recommendation and cannot provide you with the standard “90-Day Letter of Certification.” To expedite the review of your Recommendation, the MDE asks that the college also attach copies of the court’s “Judgment of Sentence” or “Register of Actions” showing how any convictions were settled.

To ensure that our teacher candidates are aware of these rules and adequately counseled regarding possible results of convictions, they are asked to complete and sign this Statement at various times throughout the program.

Name __________________________________ Social security number: ___________________

No Yes Have you ever been convicted (by verdict, plea of guilty, or plea of nolo contendere) of a felony?

No Yes Have you ever been convicted of a misdemeanor as an adult?

No Yes Have you ever been convicted or received a suspended sentence for a crime or an attempt to commit a crime which is considered sexually related?

No Yes Do you have any charges or warrants of arrest pending against you?

No Yes Have you ever had a teaching credential suspended, revoked, nullified, or otherwise invalidated?

If you answered “yes” to any question, list the date(s) and describe the nature of the conviction(s):

|Date |Nature of conviction |Previously reported on |

| | |101.1 statement? |

| | | |

|I affirm, under the penalty of committing fraud in the application process, that the statements made above are true, complete and |

|correct. I also affirm that I will report to the Teacher Education Department chair, in writing any conviction or charges that arise |

|after I submit this form. I understand that convictions will be reviewed by the MDE when my recommendation for a teaching certificate |

|is submitted and that they may impact my opportunities to find employment. |

| |

|___________________________________________ __________________ |

|signature date |

To expedite the MDE’s review of your recommendation, you are asked to provide the college’s Certification Officer with copies of the court’s “Judgment of Sentence” or “Register of Actions” showing how convictions were settled.

Note: Signed 101.1 Statements are kept in the candidate’s Teacher Education Department file. As required by the Buckley Amendment, such student records are confidential and can be reviewed only by individuals authorized by the Teacher Education Department chair.

Faculty Recommendation

Admission to Level 2 of the Professional Education Sequence

Teacher Education Department - Adrian College

Candidate __________________________________ Respondent _________________________________

Candidate: Sign this waiver before submitting to your selected respondent. “I waive the right to view the recommendation I have requested from this faculty member.” _______________________________ Date ________

To the Respondent: The above individual is applying for admission to Level 2 of the teacher education program. As a part of the application process, the Teacher Education Department considers feedback from faculty regarding the applicant’s readiness to achieve and demonstrate the Entry Level Standards for Michigan Teachers. For each criteria, circle a response to indicate as accurately and honestly as possible your assessment of the candidate’s qualifications. Please submit the completed recommendation to the Teacher Education office, North Hall 207.

Rating scale: 4 I recommend this candidate with great confidence

3 I can comfortably recommend this candidate

2 I recommend this candidate with some hesitation or concern

1 I have observed a lack of this characteristic in the candidate

0 I strongly recommend against this candidate

NB I have no basis for evaluating this candidate’s qualification

Professionalism

|Dependability, responsibility, good judgment |4 3 2 1 0 NB |

|Positive relationships with peers |4 3 2 1 0 NB |

|Respectful relationship with instructors and/or supervisors |4 3 2 1 0 NB |

|Appropriate dress, appearance, hygiene |4 3 2 1 0 NB |

Notes:

Academic preparation

|Able to learn and use new concepts and skills |4 3 2 1 0 NB |

|Strong general and/or discipline-specific knowledge |4 3 2 1 0 NB |

|Produces high quality work |4 3 2 1 0 NB |

|Communicates well in writing, reading, speaking, listening, visually representing |4 3 2 1 0 NB |

Notes:

Commitment to learning

|Responds to learning activities with curiosity and confidence |4 3 2 1 0 NB |

|Accepts academic challenges |4 3 2 1 0 NB |

|Considers and respects diverse points of view |4 3 2 1 0 NB |

|Makes effective use of technologies to strengthen learning |4 3 2 1 0 NB |

Notes:

____________________________________________ _____________________

Signature of Respondent Date

Contact me regarding my responses Please do not allow applicant to see my responses

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