Application for Admission to Teacher, Education and Clinical Teaching: Graduate (MAC)

Banner ID:
Note: Banner ID is a 9-character ID beginning with the letter "A". Example: "A12345678"

First Name                                  MI                Last Name

Address

City                                            State            Zip

Home Phone                             Work/Cell Phone

Email

Date of Birth (yyyy-mm-dd)  Gender              Ethnicity

University Status                  Faculty Advisor
Please enter email address. Example: "xyz@tamucc.edu"

Certification Level                                                   Certification Field

Certification License ID (TEA ID #)

Expected Graduation (Semester/Year)

Previous Degree(s) Held:

Are you currently employed as a Para-professional (teacher assistant)?
     If so, where?

Number of clock hours of observation completed to date

I am applying for the following program(s): Click here to view requirements for Graduate
Admission to Teacher Education
      I have read, understand, and agree to comply with all requirements for the Teacher Education Program.

Admission to Clinical Teaching
      I have read, understand, and agree to comply with all requirements for the Clinical Teaching Program.

Semester/Year to complete Clinical Teaching:

Select the district in which you would prefer to clinical teach:

Select the campus level(s) in which your certification area allows you to teach: Note: Must enter "Yes" or "No" for each campus level below
      Elementary    Middle School    High School

Is your Spanish ability such that you would be capable of clinical teaching in a primarily Spanish setting?

If you have school-age children, please list the schools they attend:
     

I am a MAC student who plans to

Do you permit us to give your information to district personnel inquiring for purposes of employment?

As a clinical teacher, I agree to hold harmless & release from liability all representatives of TAMU-CC in the event I am injured while on this assignment or in any way conclude that I am dissatisified with details related to my assignment. By checking this box, I testify that I have carefully read the information contained in this application, that the details I have provided are factual, and that I agree to abide by the statements attached.
I give permission to the Texas A&M University-Corpus Christi College of Education to submit data from this application to Texas state agencies responsible for teacher certification.