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Application for Admission to Directed Teaching and Licensure (A8) SVU

Please note: This form will NOT SAVE if you begin it now and return later to finish it. Please complete and submit the form in one session.

Questions? Contact Rebecca Perini rperini@wlu.edu.

* Name:

* Current University Email Address:

* Current Mailing Address, City, State, Zip:

* Phone Number:

* Anticipated Date of Graduation (mm/dd/yyyy):

* Current Cumulative GPA:

* Home Institution:

* Major(s):

* Minor(s):

* Parent or Permanent Address, City, State, Zip:

* Endorsement Area(s) to be Sought:

Please list Practicum placement history.

INCLUDE: Term/date, Type of Placement, School, Teacher, Grade level/subject

* 1.

* 2.

* 3.

* 4.

Term you will student teach: *

OPTIONAL: School request for directed teaching. (This is not guaranteed but we honor requests when possible). Indicate School, Teacher, Grade level/Subject.

Choice 1:

Choice 2:

Choice 3:

Please review the Directed Teaching application "Checklist to Accompany A8 form" found at rtecforms.wlu.edu and complete the required items.

* Applicant's Signature:

* Date:

This form will be submitted to the RTEC Director and you will receive a copy via email.

RTEC Form A8