Teacher Education University
Application for Admission
Educator Preparation Institute

Applicant Information
Last Name					First Name
Street Address						Date of Birth (mm/dd/yyyy)
						Social Security #
City			State			Zip Code
Email Address
Home Phone #	Work/Cell #				Other names under which your academic records may be issued:
List chronologically all-secondary educational institutions attended or currently attending.
School Name		Major		Dates Attended			Degree Received	GPA

Florida Teacher Certification Eligibility

Check all that apply

I have never applied for a Status of Eligibility letter from the Florida Department of Education.

I have applied for a Status of Eligibility letter from the Florida Department of Education but have not yet received my response.

Date application was submitted:	Teacher Certification Subject Area(s) and Grade Level(s) Requested

I have received one or more Status of Eligibility letter(s) from the Florida Department of Education.

Teacher Certification Subject Area and Grade Level	Date Letter was Issued	Results
		Eligible
		Not Eligible
		Eligible
		Not Eligible
		Eligible
		Not Eligible

I presently hold a valid Temporary Teaching Certificate from the Florida Department of Education.

Teacher Certification Subject Area and Grade Level	Expiration Date

I previously held a Teaching Certificate from Florida or another state, but it is now expired.

Teacher Certification Subject Area and Grade Level	State	Expiration Date

Teaching Experience
I have full or part time teaching experience in a K-12 public or private school.

Name and Location of School	Subject Area(s) Taught	Grade Level(s) Taught

I have substitute teaching experience in a K-12 public or private school.

Name and Location of School	Subject Area(s) Taught	Grade Level(s) Taught

I have experience teaching children or adults in a setting other than a K-12 public or private school.

Name and Location of Experience	Description of Teaching Duties

I have been a volunteer in a K-12 public or private school.

Name and Location of Experience	Description of Teaching Duties

Florida Teacher Certification Examinations and English and Mathematics Fluency

Have you passed the following Florida Teacher Certification examinations:

General Knowledge - Language	Yes No	General Knowledge- Mathematics	Yes No
General Knowledge - Reading	Yes No	Professional Education	Yes No
General Knowledge- Essay?	Yes No	CLAST (passed prior to 2002)?	Yes No
Subject Area (note area)?	Yes No	Subject Area (note area)?	Yes No

Have you completed any of the following:

Graduate level coursework?	Yes No	Praxis examination?	Yes No
Post-bachelor’s English courses?	Yes No	GRE or similar examination?	Yes        No
Post-bachelor's math courses?	Yes No

Technology Fluency

Do you have computer access at your home or office?

Yes No

Do you have an internet connection on your home computer?

Yes No

How would you rate your technology skills with each of the following?

	I am very familiar and confident with this	I know the basics, but need help with advanced elements	I know what this is, but can’t do it without help	I don’t know anything about this at all
Sending and reading e-mail
Sending e-mail attachments
Searching the internet
Word processing(MS Word, WordPerfect, etc)
PowerPoint
Using a jump drive
Saving files to a CD
Electronic portfolio
Creating & maintaining spreadsheets

Have you taken college courses in computers, software or technology?

Yes No

If yes, please describe the course you have taken.

Employment Eligibility

Are you a U.S. citizen or are you legally authorized to work in the United States?

Yes No

Are you 18 years of age or older?

Yes No

Criminal History

• All candidates for teacher certification in the state of Florida must pass rigorous level 2 background screening and fingerprinting.
• All EPI applicants must pass level 2 background screening before they will be allowed to participate in field experiences.
• You are advised to answer each of the following questions fully and honestly.
• Report of criminal offense does not necessarily mean that you will be ineligible for the EPI Program or for Florida Teacher Certification.

Have you ever been convicted, pled guilty or pled nolo contendere to a criminal offense, other than a minor traffic violation (including, but not limited to a felony, gross misdemeanor, misdemeanor, or DUI)?	Yes No	If yes, please describe the specifics of the situation.
Have you ever received probation, deferred judgment, or pre-trial intervention?	Yes No	If yes, please describe the specifics of the situation.
Have you ever been arrested (even if no contest or charges dropped or pled down) for a crime?	Yes No	If yes, please describe the specifics of the situation.
Are you currently under investigation, or been named in an indictment, accusation, or special presentment of any offense, other than a minor traffic violation?	Yes No	If yes, please describe the specifics of the situation.
Are you under investigation, or have you been charged with any violation of the Florida Code of Ethics for Education or any similar inquiry in any other state?	Yes No	If yes, please describe the specifics of the situation.
Have you ever been named by a state agency responsible for child welfare as a perpetrator in an indicated report of child abuse or neglect?	Yes No	If yes, please describe the specifics of the situation.
Have you ever had a report of child abuse or sexual activities involving a K-12 student or minor filed against you with a school district, a state or federal agency, a police agency, or in court?	Yes No	If yes, please describe the specifics of the situation.
Have you ever been disciplined by any public agency responsible for licensure of any kind, including but not limited to educational licensure?	Yes No	If yes, please describe the specifics of the situation.

To complete your application process the following documents must also be submitted to the EPI program coordinator:

(All documents must be received prior to scheduling an interview with the EPI Student Selection Committee.)

• Your up-to-date resume.
• Official transcripts from the college or university from which you earned your bachelor’s degree showing the date on which your degree was conferred, the type of degree earned, and your GPA.
• Copies of your Official Statement of Status of Eligibility and Florida Teacher Certification Exams (either General Knowledge or Subject Area).
• Three letters of reference which describe your suitability for a career in education.
• At least on reference must be from a current or former employer or teacher.
• No more than two reference letters may be provided by family members or personal friends.
• Each letter must include the following:
• How long the person writing the reference has known you and what their relationship is to you.
• Explanation of why the person writing the letter thinks you would be a good teacher.
• Name and contact information of the person providing the reference (address, telephone number, email address)

• $50.00 application fee made payable to Teacher Education University

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