APPLICATION TO TAKE EDUCATOR PREPARATION/DEVELOPMENT COURSEWORK (Teacher, School Administrator, or School Pupil Services) BOWLING GREEN STATE UNIVERSITY Please complete the form electronically, print, and mail or fax the paper copy along with the Guest (Undergraduate) or the Non Degree Graduate Application form to the Office of Registration and Records on the BGSU main campus or on the Firelands campus. The form will be forwarded to the Office of Accreditation and Licensure in the College of Education and Human Development (main campus) for processing Name: ID#: Current Date: Desired Enrollment Term/Year: Phone #1: Phone #2: Email Address: Section A: Please place an “X” in the box next to either statement #1 OR #2 to indicate your current educator licensure status; Under #1 OR #2, place a “X” in front of a, b, c, d, or e (select one only) to indicate your primary purpose for taking educator preparation coursework at BGSU I hold a current or expired teacher, administrator, or pupil services certificate/license in (indicate content area; box will expand) from the following state(s): a I wish to take educator preparation coursework for personal development purposes only b I wish to take educator preparation coursework for certificate/licensure renewal purposes only c I wish to take educator preparation coursework as a guest undergraduate student or a nondegree graduate student while my admission to a graduate certificate or degree program is pending. I have applied to the following program: d I wish to take educator preparation coursework as a guest undergraduate student or a nondegree graduate student to add a new license or a new endorsement. Please proceed to Section B to indicate desired license or endorsement e Other (please indicate) I DO NOT hold a current or expired teaching, administrator, or pupil services certificate/license a I wish to take educator preparation coursework for personal development purposes only b I wish to take educator preparation coursework as a guest undergraduate student or a nondegree graduate student while my admission to a graduate certificate or degree program is pending. I have applied to the following degree program (box will expand): c I wish to take educator preparation coursework as a guest undergraduate student or nondegree graduate student to pursue initial licensure. Please proceed to Section B to indicate desired license or endorsement d Other (please indicate) Note: If you marked “1d.” or “2c.” and have nonBGSU coursework that should be reviewed for eligibility consideration, please send official transcripts to the Office of Accreditation and Licensure, 455 Education Building, BGSU, Bowling Green, OH 43403 +Transcripts may be anticipated from the following Institution(s): Section B: If an “X” was placed by #1d OR #2c above, please place a “X” beside your desired licensure or endorsement area in the chart below: TEACHING LICENSES—Unless otherwise indicated, all teacher licensure programs are at the undergraduate level; *Programs with asterisks (i.e., “*”) following the title require graduate program admission: ADOLESCENT/YOUNG ADULT (GRADES 712) Adolescent/Young Adult (Secondary) Education—Select one area of specialization below: Earth Sciences Integrated Science (pending) Life Sciences and Physics Earth Sciences and Chemistry Integrated Social Studies Physical Sciences: Chemistry Earth Sciences and Physics Life Sciences Physical Sciences: Chemistry and Integrated Language Arts Life Sciences and Chemistry Physics Integrated Mathematics Life and Earth Sciences Physics Physical Sciences: Physics CAREER TECHNICAL (VOCATIONAL; GRADES 412) Business Education (Integrated)— Marketing Education— Undergraduate level Undergraduate level Business Education* (Integrated)— Marketing Education* (must Work Force Development (formerly, Route B, 24Hour Program)—Select program area(s): 11.02.2011 APPLICATION TO TAKE EDUCATOR PREPARATION/DEVELOPMENT COURSEWORK Graduate level register under Business Education) —Graduate level Business Marketing To pursue this program at BGSU, an individual must have been offered an applicable teaching position and have a CTE37 form signed by the employing superintendent or designee. In addition, the individual must already hold a teaching certificate or license *Programs with asterisks (i.e., “*”) following the title require graduate admission EARLY CHILDHOOD (GRADES PREK3) Early Childhood Education INTERVENTION SPECIALIST (UNLESS OTHERWISE INDICATED, GRADES K12) Deaf/Hard of Hearing— Mild/Moderate—Undergraduate Undergraduate level (PreK12) level Mild/Moderate—Graduate level Moderate/Intensive Intervention Specialist—Undergraduate level Moderate/Intensive Intervention Specialist—Graduate level MIDDLE CHILDHOOD (GRADES 49) Individuals pursuing first/initial licensure must select two concentrations; individuals holding Ohio certificates/licenses may select one or two concentration areas (please indicate desired concentration[s]) Middle Childhood Mathematics Reading/Language Arts Science Social Studies MULTIAGE (GRADES PREK12) Music Education—Select one area of specialization: Choral Classroom/General Music Physical Education Visual Arts—Art Education—Select one area of specialization: ThreeDimensional Studies TwoDimensional Studies World Language—Select one area of specialization: French Latin German Russian Instrumental Spanish TEACHING ENDORSEMENTS—Please indicate desired endorsement and enrollment status: U = Enrolled as a Guest (Undergraduate) or a Guest pending undergraduate degree program admission; PB = Enrolled as a Guest (Undergraduate) or NonDegree Graduate pursuing post baccalaureate licensure; GC = Enrolled as a Nondegree Graduate pending Graduate Certificate program admission; G = Enrolled as a NonDegree Graduate pending graduate program admission Adapted Physical Education Classroom Technology* Early Childhood Generalist (45) Limited to physical education license (Computer/Technology) Limited to Early Childhood license U GC G U PB GC Middle Childhood Generalist 46 P6 Mathematics Specialist* P6 Science Specialist* Limited to middle childhood license Limited to prekindergarten, Limited to kindergartenprimary, with two areas elementary, early childhood, middle elementary, early childhood, middle U PB childhood, high school, or AYA childhood, high school, or AYA Language Arts/Reading mathematics licenses science licenses; 3 years experience GC GC Mathematics Science Social Studies Reading* Transition to Work GC G PB Limited to intervention specialist or careertechnical licenses ADMINISTRATIVE LICENSES—All administrative licensure programs are at the graduate level only ADMINISTRATIVE SPECIALIST Curriculum, Instruction, and Educational Staff Personnel School Community Relations* Professional Development* Administration* Educational Research* Pupil Services Administration* PRINCIPAL—Mark all that apply Principal, ages 312; Grades PK6* Principal, ages 814; Grades 49* Principal, ages 1021; Grades 512* SUPERINTENDENT 11.02.2011 APPLICATION TO TAKE EDUCATOR PREPARATION/DEVELOPMENT COURSEWORK Superintendent* PUPIL SERVICES LICENSES—All pupil services licensure programs are at the graduate level only School Counselor* School Psychologist* School SpeechLanguage Pathologist* *Programs with asterisks (i.e., “*”) following the title require graduate admission Comments: 11.02.2011