| Part I: Applicant Information |
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| Last Name:
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First Name:
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Middle Initial:
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| Candidate ID # (last 4 digits of your SSN):
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| Current Mailing Address:
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| City:
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State:
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ZIP:
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| Phone:
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Email Address:
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| Summer Mailing Address (if different):
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| City:
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State:
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ZIP:
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| Phone:
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Email Address:
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The following information is required
for statistical reporting only. It is not used to identify any candidate
and it
does not affect the candidate’s application. |
| Birthdate: (mmddyyyy)
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Gender:
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Ethnicity:
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When do you anticipate starting your professional program courses?:
Have you taken the Praxis I ?:
Exempt
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Education Status: (check the appropriate box)
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| Semester Planning To Complete Teaching Internship:
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| Part II: Statement of Disposition |
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Dispositions are the values, commitments and professional
ethics that influence behaviors toward
students, families, colleagues, and communities; they affect student
learning, motivation, and
development as well as the educator’s own professional growth.
Dispositions are guided by beliefs and
attitudes related to values such as caring, fairness, honesty, responsibility,
and social justice.
Choose two or three traits that you possess, and discuss how they will
help you to be an effective teacher.
(Do not exceed 250 words.) |
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| Part III: Special Information |
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The following two statements require your attention.
STATEMENT 1:
USC Aiken provides affirmative action and adheres to the
principle of equal educational and
employment opportunity without regard to race, color, religion, sex,
creed, national origin, age,
disability or veteran status. This policy extends to all programs and
activities supported by the
university. Any person who feels they qualify for special accommodations
due to a physical,
learning, or psychological disability should contact the Office of
Disability Services at (803)
641-3609 for a free, confidential interview.
STATEMENT 2:
Have you ever been arrested, convicted, found guilty, entered
a plea of no contest, or had
adjudication withheld in a criminal offense (including DUI) other
than minor traffic violation; or
are there any criminal charges now pending against you? Failure to
answer this question
accurately could cause denial of certification.
A Yes or No answer
is required.
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By checking this box I acknowledge this as my electronic
signature and as such certifies that all
of the information contained in this application is factually correct,
is honestly presented, and
contains no significant omissions. If, at a later date, it becomes clear
that this is not true, I agree
that the University may revoke any offer of admission it makes to me or
to dismiss me from the
University. |
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