Application for Admission to The

Application for Admission to The


Name ______SAUIDNumber______

(Please Print Legibly) Last First MI/Maiden Last 4 Digits of SS# ______


Street City State Zip

Phonenumber(Home) ______(Cell) ______

Email: School______Personal ______

TEACHING MAJOR: Content Area ______Grade Level ______Minor Field ______

Semester Hrs. Completed ______GPA ______Anticipated Student Teaching Semester and Year ______

3.0 GPA required as of August 1, 2016.

Praxis I--CORE Scores**: Reading: ______Writing: ______Math: ______
156 162 150
ACT**: Composite Score:_____ Reading: _____ Math: _____ English/Writing: _____
24 22 22 22
SAT**: Reading: _____ Math: _____ Writing/Language: _____
27 540 29

Must have a C or Higher (CR in Field Exp. I) for the following Courses:

Comp. I _____Comp. II _____College Algebra _____ Intro to Education _____Field Experience I _____Speech _____


(To be signed by Student, Advisor and the Dean of Education)

By signing this form:

  • The advisor is verifying that a conference was held with the student and that the student, having completed all the above requirements,is qualified for admission to the Professional Education Program.
  • The student is acknowledging that He/She has received and understands the Dispositionsrequirements as defined by the Educator Preparation Provider. Please attach copies of any Dispositions that have been formally lodged, i.e.,

Introduction to Education dispositions form(s) in LiveText.

  • The student is also verifying that He/Sheunderstands that ALL Praxis II exams must be taken before the Student Teaching Block.
  • The student is allowing the AFEL Office and their Program Faculty to talk to current and prospective employers in regards to their progress in the program and their current licensure status.


Student’s Signature Date


Advisor’s Signature Date


Signature: Director of Admissions, Field Experience, and Licensure Date

Entered in database: Date____ Initials ____ Copy returned to Advisor: ______


RUBRIC: Dispositions Initial Programs

Dispositions evaluation becomes part of your permanent record. If a score of progressing is given a formal disposition meeting will occur.

(3pts) / Basic
(2pts) / Progressing
(1pt) / N/A
(0 pts)
Attendance / Attends regularly. / Irregular attendance with notification. / Irregular attendance without notification.
Punctuality / Mostly on time (responding to emails, for appointments, and on classwork) / Occasional lateness. (responding to emails, for appointments, and on classwork) / Frequent lateness is a problem. (responding to emails, for appointments, and on classwork)
Initiative / Demonstrates independence and initiative by finding resources. / Operates independently with direction and uses only resources provided. / Needs step-by-step instruction and neglects available resources available.
Professional Ethics / Demonstrates adherence to standards of professional ethics. / Demonstrates limited concern for professional ethics. / Engages in unethical behavior.
Cultural Sensitivity / Demonstrates respect toward diversities. / Occasionally demonstrates respect towards diversities. / Demonstrates disrespect towards diversities.
Interaction with Others / Comfortable and respectful when interacting with others at all times. / Occasionally comfortable and respectful when interacting with others. / Struggles to be comfortable and respectful when interacting with others.

*If a disposition is created on a student in LiveText a copy should be sent to the AFEL office. If a disposition is created on the student and is not submitted through LiveText then a copy must be sent to the candidate, instructor, and the AFEL office.