University of Arkansas at Pine Bluff



University of Arkansas at Pine Bluff

Admission to the Professional Semester

Student Teaching

Teacher Candidate: ___________________Student ID #__________Date: _____________________

|CHECKLIST/APPLICATION INSTRUCTIONS |DATE RECEIVED |

|Submit application for admission form. | |

|Submit a copy of Approved Degree Plan (Approved by Advisors). The Degree Plan must contain the signature of the | |

|advisor(s), chairperson and Dean of the School of Education (where required). | |

|Submit University Clearance Form (Finalized week of Student Teacher Clinical Seminar). | |

|Submit a Student Arkansas Education Association (S-AEA) application form beginning the semester student teaching is | |

|to be completed. (fall or spring) or show that he/she possess proof of $100,000 liability insurance policy. | |

|Submit a letter of recommendation from advisor or department chairperson. | |

|Provide an official up-to-date transcript of all college courses including transfer courses from other colleges or | |

|universities. The transcript must reflect a Cumulative Grade Point Average of 2.70 or above. | |

|Attach an original copy of all test scores: | |

|Act Score 21.25 and a Score of 7 or above in Writing | |

|Praxis II: Content Knowledge/Subject Assessment | |

|Principles of Learning and Teaching/Pedagogy | |

|Special Education Majors do not take PLT | |

|Special Education Core Knowledge and Applications (5354) | |

|Fundamental Subjects: Content Knowledge (5511)On-Screen Scientific Calculator provided). | |

|For candidates starting a program beginning fall 2017, this license requires a reading test-Foundations of Reading. | |

|More information about this test is available on the Arkansas Division of Elementary and Secondary Education web | |

|page. | |

|Elementary K-6th Grades Majors have to take the following CK; | |

|Elementary Education Multiple Subtests (5001)-If you plan to take all tests during one (1) setting (5001): | |

| | |

|Elementary Reading & Lang Arts Subtest (5002) | |

|Elementary Mathematics Subtest (5003) | |

|Elementary Social Studies Subtest (5004) | |

|Elementary Science Subtest (5005) | |

|For candidates starting a program beginning fall 2017, this license requires a reading test-Foundations of Reading. | |

|More information about this test is available on the Arkansas Division of Elementary and Secondary Education web | |

|page. | |

|Foundations of Reading if enrolled fall’17 going forward. | |

|STUDENT TEACHERS MUST ATTAIN PASSING SCORES ON ALL | |

|TESTS PRIOR TO THE START OF STUDENT TEACHING. | |

|Submit proof of a recent negative TB Skin Test. (No older than 3 months) | |

|Provide a Doctor Statement (a complete Physical Examination). | |

|Obtain the UAPB Nurses’ signature on the Campus Clearance Form prior to the start of the Professional Semester. | |

|Submit proof of Authorization For Release of Confidential Information Contained within the Arkansas Child | |

|Maltreatment Central Registry | |

|Submit proof of Individual Record Check Form, Background Check Consent Form and Electronic Finger Printing. | |

|IDEAS Course Certificates: | |

|Child Maltreatment (2hrs.); | |

|Gatekeepers: Youth Suicide Prevention Awareness (3hrs); | |

|Parental Involvement (2hrs.)-Parental Involvement –students will need to take at least 2 separate courses in order to| |

|equal the two (2hrs) needed; | |

|Dyslexia Awareness (1hrs). | |

|The directions for : Go to . If that website does not work, type it in | |

|google and click on it from there. Click on create a new account and sign up using the correct spelling of your name | |

|that you used when you signed up for fingerprinting. When asked to choose an organization, click on University | |

|Preparatory Program and then click on UAPB. It should let you in. To get to the courses, click find learning at the | |

|top of the website and then click on courses. Type in the above mentioned name of the courses you have to take and | |

|enroll in them. | |

| | |

|Student teachers must show proof that he/she has exited University College and must have been admitted to the School | |

|of Education prior to submission of this application. | |

University of Arkansas at Pine Bluff

Pine Bluff, AR 71601

Application for Admission to Student Teaching

(Please Type) (Do Not Fold)

Date: ___________________________

I, ________________________________, hereby apply for permission to register for Student Teaching for the_____________Semester of the academic year 20______.

My major is __________________________________________________________.

I understand that the Admission, Retention and Exit Committee has the authority to deny my admission or withdraw me from student teaching, if I do not attain or maintain the required standard for admission and continuance.

____________________________________________

Signature

01. Name: ___________________________________________________________

(Last) (First) (Middle or Maiden Name)

02. Gender: _____________ Social Security Number: _________________

03. If your are a Music Major, indicate if you are vocal or instrumental:________

04. Are you being certified K-12? If so, what are the areas or levels in which you are seeking certification? ____________________________________________

( ) K-6th Grades -Elementary Education

( ) Middle Level (4th -8th Grade) - Science and Mathematics

( ) Middle Level (4th -8th Grade) - Science and Social Studies

( ) Middle Level (4th -8th Grade) - Mathematics and Social Studies

( ) Middle Level (4th -8th Grade) – Language Arts and Social Studies

( ) Middle Level (4th -8th Grade) - Language Arts and Mathematics

( ) Middle Level (4th -8th Grade) - Language Arts and Science

( ) Middle Level (4th -8th Grade) - Language Arts, Math, Science and Social Studies

( ) Secondary Grades (7th- 12th Grades) Major Area: __________________________

( ) K-12th Grades (K-12th Grades) Major Area: ____________________________

Degree Plan Approval Date: ____________________________________________

(Attach Approved Degree Plan to Application)

05. Praxis Exam Scores

|Art K-12 Test Code: #5134 |Cont. & Analysis |PLT 157 |

| |Passing Score: 158 | |

| | | |

|Business Technology |Business Education : Content Knowledge | |

|Test Code: #5101 |Passing Score: 154 | |

|Elementary Education K-6 |Elementary Education Multi Subject: 5001 |PLT 160 |

| |Reading/Lang/ Arts #5002 Passing Score | |

|Test Codes are listed after each subtest: |157 | |

| |Mathematics #5003 | |

| |Passing Score 157 | |

| |Social Studies #5004 | |

| |Passing Score 155 | |

| |Science #5005 | |

| |Passing Score 159 | |

|English Education |English Lang, Lit &Comp: |PLT 157 |

|Test Code: # 5039 |Content & Analysis | |

| |Passing Score: 168 | |

|Family & Consumer Science |Family and Consumer Science CK: 153 |PLT 157 |

|Test Code: #5122 | | |

|Middle Level Education 4-8 |Must have 2 of the Subject Areas Passed: |PLT 160 |

| |Middle School Language Arts #5047 Passing | |

| |Score: 164 | |

| |Middle School Math #5169 Passing Score: 165 | |

| |Middle School Science #5442 | |

| |Passing Score: 147 | |

| |Middle School Social Studies # 5089 | |

| |Passing Score: 149 | |

|Agri Science Technology #5701 |CK 147 | |

| | |PLT 157 |

| | | |

|Industrial Technology #5051 |CK 159 |PLT 157 |

| | | |

|Life/Earth Science | |PLT 157 |

| | | |

| Biology/Life Science #5235 |CK 142 | |

| | | |

| Chemistry #5245 |CK 150 | |

| | | |

| | | |

|Physical Science: Chemistry # 5245 or Physics|Chemistry CK: 150 or Physics CK: 135 | |

|#5265 | | |

|Physics #5265 |CK: 135 | |

|Mathematics | |PLT 157 |

| | | |

|Content Knowledge #5161 |CK 160 | |

| | | |

| | | |

| | | |

|Music Instrumental & Vocal Test Code # 5113 |Cont. & Instr. 162 | |

| | |PLT 157 |

| | | |

|Physical Education, Wellness, & Leisure | | |

| | |PLT 157 |

|Health & Physical Ed Test Code # 5857 |CK 144 | |

| | | |

|Physical Ed: Content & Design/Coaching Test Code # 5095 |C & D/Coach 169 | |

| | | |

|Social Studies |Cont. & Interp. 153 | |

|Test Code #: 5086 | | |

| | |PLT 157 |

06. Permanent Home Address: _________________________________________

_________________________________________

Local Address: __________________________________________

_________________________________________

Telephone Number: __________________________________________

(Permanent) (Local)

07. Is Student Teaching the last course you need to complete your degree requirements?

Yes_________

No__________ *Please list course(s) needed.

_________________________________ _____________________________

_________________________________ _____________________________

_________________________________ _____________________________

If for any reason I cancel or postpone my student teaching during the semester stated on this application, I agree to submit a written statement to the Chairperson of the Admission, Retention and Exit Committee before the end of the semester in which my application was submitted and the statement will become a part of my permanent student teaching file. I understand that when I do elect to do my student teaching, I must reapply at the appropriate sign-up period.

_____________________________________________ ___________________

Student’s Signature Date

_____________________________________________ ___________________

Advisor’s Signature Date

_____________________________________________ ___________________

Academic Advisor Secondary Education Major Da

University of Arkansas at Pine Bluff

School of Education

TO: DEPARTMENT CHAIRPERSON OR ADVISOR

_____________________________________ Date: ________________________

Department Chairperson/Advisor

Student: __________________________has made application for enrollment in Directed Teaching. Your candid opinion of the applicant in the following areas is desired. Will you please rate the applicant on the form below and return it to the School of Education, Dawson Hicks Hall? Check each item under one of the rating columns.

|Recommendation from the Chairperson/Advisor |

|TRAITS |No Opportunity to |Weak-needs |Satisfactory |Strong- |

| |observe |improvement |acceptable |Highly |

| | | | |Competent |

|01. Conscientious desire to Teach | | | | |

|02. Ability to work hard at task upon | | | | |

|completions | | | | |

|03. Willingness to work diligently | | | | |

|04. Ability to get along with people | | | | |

|05. Desire to work with people | | | | |

|06. Warm feeling for young people | | | | |

|07. Physical Health | | | | |

|08. Mental Health | | | | |

|09. Pleasing manner, appearance, | | | | |

|habits and conduct | | | | |

|10. Sufficient maturity to take complete | | | | |

|charge of a group of pupils | | | | |

|11. Leadership qualities | | | | |

|12. Communicative skills | | | | |

|13. Mastery of subject manner | | | | |

|14. Initiative | | | | |

|15. Resourcefulness | | | | |

|16. Ethical character | | | | |

|17. Open mindedness | | | | |

|18. Responsibility and reliability | | | | |

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