California University of Pennsylvania | Cal U



DATA SHEET

Administrative Leadership Programs

Please return to:

California University of Pennsylvania

Office of Graduate Studies & Research

250 University Ave., Box #91

California, PA 15419

Last Name:       First Name:       MI:      

Street Address:       City:       State:       Zip:      

Home Telephone:       Work Telephone:       Email:      

Candidate is seeking:

K-12 Principal Certification

K-12 Principal Certification and Master’s of Education

Superintendent Letter of Eligibility

Superintendent Letter of Eligibility + Doctor of Education in Education Administration and Leadership (EdD)

Doctor of Education in Education Administration and Leadership (EdD) (Already hold SLE certification)

EDUCATIONAL BACKGROUND[pic]

Degree/Year Obtained/College-University/Major

     

     

Certification/Year Obtained/College-University

     

     

EDUCATION WORK EXPERIENCES: (List present position first)

[pic]

Position/Grade/Subject/District/Years

     

     

Professional Organizations: (Include office held, committee, etc.)

     

     

Educational and Community Achievements:

     

List Other Pertinent Achievements:

     

How did you hear about the program to which you are applying?

Internet Search

Email

Mailing

Cal U Alumni (please include name of Alumni)      

Friend/Colleague

Direct Contact w/University

Conference (please indicate which conference)      

Electronic Banner Ad (please indicate which site)      

Journal/Publication (please indicate which publication)      

Other (please list)      

Are you a Cal U alumnus?      

Non-Pennsylvania Students Only

Current state of residence      

Will you be applying for certification in your current state of residence? Check one: Yes No

If you are seeking certification in a state other than Pennsylvania, it will be important for you to check with your state Department of Education requirements and whether completing the Administrative Program at Cal U will be accepted. 

Non-Pennsylvania students who plan to seek Pennsylvania certification are required to notify us of that intent in order to meet the PA certification expectations. Additional information related to Pennsylvania certification can be located at the Pennsylvania Department of Education website.

After completing the administrative leadership program, will you pursue certification from the PA Department of Education? Check one: Yes No

“I have read and understand the intent to pursue certification statement.”      

Signature / Date

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