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Division of Education

Division of Education

Teacher Education Program (TEP)

K - 6 (Elementary Licensure) & Early Childhood Licensure
K - 6 & ECH Application for Admission to TEP

Biographical Details:

Last Name	First Name	Middle Initial
Street	City	State	Zip
Phone Number (Include Area Code e.g. 555-555-5555)	E-Mail Address	IU Identification

Educational Background:

I am applying to the following program
Elementary Degree and Licensure
Early Childhood Degree and Licensure

My overall GPA is

I have passing scores on all 3 sections of PRAXIS I (PPST)
Yes M199 is posted on my transcript
I will deliver a copy of the score report

Core Curriculum:

If you are completing a B.S. degree at IU Kokomo, the IU Kokomo Core Curriculum must be completed prior to admission into TEP. Indicate a grade for each course. If you are currently enrolled the grade is IP for in progress.

ENG W131	Grade	If you have transfer credit, indicate the Institution
ENG W132	Grade	If you have transfer credit, indicate the Institution
SPCH S121	Grade	If you have transfer credit, indicate the Institution
MATH M125	Grade	If you have transfer credit, indicate the Institution
OR MATH M118	Grade	If you have transfer credit, indicate the Institution

Pre-Professional Courses:

Indicate a grade for each course listed below.

M101 (undergraduates only)	Grade	If you have transfer credit, indicate the Institution
P250	Grade	If you have transfer credit, indicate the Institution
Q200	Grade	If you have transfer credit, indicate the Institution
K205	Grade	If you have transfer credit, indicate the Institution

If you do not have a grade and you are currently advanced registered, you must bring a copy of your schedule confirmation or a copy of your advance registration to the Education Office. You may print either of these forms from OneStart

Start Dates:
State the month and the year you plan to begin TEP Core II course:
State the month and the year you plan to begin student teaching:

NOTE: Applications are due on November 1st for the following year.

Criminal Record:
Have you ever been investigated for, charged with, or pleaded guilty or "no contest" to any crime involving sexual misconduct with a minor?
Yes
No

Have you ever been convicted of a felony?
Yes
No

If the answer is yes to either question, submit a written explanation (date of charge, offense in question, court action, and address of court involved).

ALL APPLICANTS: Please read the follow statement concerning Limited Criminal History Reports: Limited Criminal History Report A Limited Criminal History Report details a person's record of arrest, indictment, information or other formal criminal charges and final dispositions. School corporations are primarily concerned about felony violence, sex, drug, or alcohol related issues. Minor offenses such as traffic or parking violations are typically not an issue. If you answered yes to either question above, you should continue with this application only if you believe your record will be acceptable to the central Indiana school corporations in the IU Kokomo service area. Prior to each semester in which you will be enrolled in courses within the Teacher Education Program you must have a current Limited Criminal History Report on file in the Education Office. In addition, you must include a detailed explanation of the offense to be considered for acceptance (date of the charge, offense in question, court action, and address of the court involved). IU Kokomo can only admit you to the Teacher Education Program if the local school corporations agree to accept you for field-based assignments. Each school corporation has its own criteria and policies related to criminal history checks, and students will be required to have a criminal history check completed and on file before participating in each field experience and student teaching activity. The schools reserve the right to refuse assignments on the basis of criminal history information or other performance, behavior, or conduct not in the best interest of the school corporation, its employees, or its students. The IU Kokomo Division of Education, therefore, reserves the right to terminate a student from the Teacher Education Program if school officials deem the student has an unacceptable criminal history background and, as a result, the student is unable to complete the field-experience requirement. A complete explanation regarding the deadlines, process, and procedure for obtaining a Limited Criminal History Report is available on the Division of Education website at: http://www.iuk.edu/~koeduc/CriminalHist.shtml Approved 9/20/06

Media Release:

I give the IU Kokomo Division of Education permission to use photographs or videos of me or samples of my work for educational presentations, publication, or promotional purposes. Please note that your admission to or your progress within the IU Kokomo Teacher Education Program is in no way contingent upon your consent.

Applicant's Statement:

By checking this box, I hereby certify that the above information is, to the best of my knowledge, true, accurate, and complete. Any falsifications of this record will be sufficient cause for disqualification and dismissal.