ࡱ> JLI] ^bjbj11 4,[,\[,\Vbbbbbvvv8,$v=84=6=6=6=6=6=6=?B6=b6=bbK=bb4=4=d*|+  * =a=0=* C C$+ Cb+DL;6q,6=6=(v= C> (: Kentucky State University School of Education MASTER OF ARTS IN SPECIAL EDUCATION (LBD K-12) Admission to Educator Preparation Program (EPP) Application (Please, type or print) Candidate: _________________________________________________________________ Date: _____________________ Last First Middle Maiden Permanent Address: __________________________________________________________________ Tel.: _________________________ Street City State Zip Code E-mail Address: ________________________________________________________________________________________________________ KSU Student ID#: ____________________________________ Date of Birth: ______/ _____/________ Gender: ___________________ Ethnicity (Check one): ___ Non-resident Alien ___Black, not Hispanic Origin ___American Indian or Alaskan Native ___ Asian/Pacific Islander ___ Hispanic ___ White, not Hispanic Advisor: ____________________________________________GPA (min. 3.0): ___________Credit Hours Completed: _______ (min. 12) Semester/Year of Admission to KSU Graduate Program:____________ Estimated Semester and Year of Graduation: _______________ Teaching Status : (Check one) _____I am currently a full-time teacher of record in an accredited public school. _____I have served as full-time teacher of record in an accredited public school for three (3) of the last five (5) years. _____I have not served as a full-time teacher of record in an accredited public school. I hereby apply to the Kentucky State University Teacher Education Committee for admission to the EPP and provide evidence that I have achieved each of the following criteria for admission to the Educator Preparation Program: Satisfaction of all Graduate School admission requirements A minimum of 12 semester credit hours or more of course work with C or better (must include ESP 502, 504, 505, and 507) and a cumulative GPA of 3.0 Two letters of recommendation, addressed to the Teacher Education Committee Completed Portfolio in LiveText- Phase I (see page 2) LiveText Username:__________________________________ LiveText Password:_________________________ I authorize the University to submit confidential credentials to the Teacher Education Committee for evaluation to determine my compliance with Kentucky State University Standards and regulations for admission to the EPP. I understand that if I am admitted to the EPP, it is my responsibility to maintain credentials that are in compliance with University and Kentucky standards and regulations; and if I plan to teach in a state other than Kentucky, I also have to be in compliance with that states standards and regulations. Furthermore, I certify that answers submitted are true and accurate to the best of my knowledge, for falsified statements on this application or other documents, unsatisfactory academic progress, failure to maintain appropriate credentials, or disciplinary action by the university against me, shall be considered sufficient cause for the Teacher Education Committee to expel me from the EPP. Signature: ________________________________________________ Date: _____________ Masters in Special Education Admission to EPP Portfolio Requirements Phase 1 Submit a complete, electronic portfolio in LiveText that includes the following artifacts: Professional Photograph (No Glamour Shots, Party Photos, etc.) Autobiographical Sketch This is a maximum two-page document revealing the following A strong desire to learn A strong desire to become an effective teacher A genuine interest in people, especially young people The ability to work well with others, A willingness to go beyond average expectations in hours devoted to study and involvement in school and community activities. Current Resume and Professional Goals Statement Graded Hallmark Assignments for ESP 502, 504, 505 and 507. Philosophy of Education written in APA format. Explanatory Essay of the Conceptual Framework in APA format with references (at least two). Disposition cumulative scores from field experiences in the aforementioned courses where applicable. Copies of Character and Fitness, Signed Kentucky Teacher Code of Ethics, Signed Code of Ethics for CEC Documentation in LiveText of completed field hours (where applicable) in the aforementioned courses.     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