Masters of Arts in Education
Program Application
Fall 2008
Deadline: May 1, 2008
PLEASE PRINT CLEARLY
Name
Last First Middle Maiden/Former
Address Home Phone ( )
Street Unit/Space Include Area Code
Work Phone ( ) City State Zip Include Area Code
E-mail Address: please print exactly (lower/UPPER case)
Social Security # - - Date of Birth / /
Gender: M □ F □ Ethnic Identity (Optional)
(Gathered for state reporting purposes only)
University granting Bachelor’s Degree:
Academic Major:
Education Employment Experience: Please complete the following starting with your current position.
Name of School Name of District Years of Service Assignment
______
______
______
Please add an additional page if needed.
1. University Graduate Application
□ Application has been submitted online at www.csumentor.edu along with the $55.00 application fee.
Arrange to have one set of official transcripts mailed directly to the CSU Channel Islands Office of Admissions from each college or university attended, including your degree posted and date awarded. CSUCI students do not need to submit transcripts previously submitted to CSUCI Admissions Office.
Please list ALL colleges and universities attended. A cumulative grade point average of 3.0 in Post Baccalaureate or graduate work is required.
Name of Institution / Date of Attendance / Degree Received2. Program Application
□ Receipt for application fee of $25.00 from the cashier’s office attached.
The Credential Program application fee of $25.00 will need to be paid at the Cashier’s Office located on the first floor of the Professional Building in the Enrollment Center, prior to submitting your application to the Credential Office
3. CBEST Exam
□ CBEST passed on ______and copy of score report attached.
4. Copy of a valid California credential.
Attached is one of the following:
□ Copy of a valid California teaching credential requiring a baccalaureate degree and a program of
professional preparation, including student teaching
□ Copy of a valid California Designated Subjects teaching credential provided the applicant also
possess a baccalaureate degree
□ Copy of a valid California services credential in Pupil Personnel Services, Health Services,
Library Media Teacher Services, or Clinical or Rehabilitative Services requiring a baccalaureate
degree and a professional preparation program including field practice or the equivalent.
5. Writing Sample
□ Attached is a written statement of purpose (500-600 word essay). Your essay should describe why you desire to be a school administrator serving the children and families of the diverse communities of California and will include personal and professional reflection on personal goals and developing the knowledge and skills to achieve these goals.
6. Two Letters of Recommendation from professional who are knowledgeable of your professional work at least one of whom is your current school administrator. (Use the forms included).
□ Attached are two recommendation forms in separate, sealed and signed envelopes.
7. Verification of Experience (use the form included)
□ Attached is the Verification of Experience form (CL-41EXP) verifying at least three years of
successful teaching or service experience (substitute or part time experience does not apply).
8. Notification Form
□ Attached is the completed Notification Form by your school district administration. (use the from
included)
An interview for qualified candidates. Information regarding interviews will be mailed to you only when your application is complete and your file has been evaluated. Students are not eligible for financial aid until admitted to the Masters Program. In order to be admitted to the Masters Program the application must be completed, all requirements met including a successful interview.
Recommendation for Admission
Masters of Arts in Education Program
¨ Educational Leadership ¨ Special Education
The applicant named below is seeking admission to the Masters of Arts in Education Program at CSU Channel Islands. CSU Channel Islands seeks to admit educators who a have strong teaching background (minimum of three years) and who demonstrate the personal and professional potential to become highly successful school leaders committed to improving the learning environment for all students. Academic skills, standards of moral and ethical behavior, and a commitment to work on behalf of all children are essential prerequisites for success.
Please give us your assessment of the applicant based on these criteria in this confidential recommendation form. Please complete both sides of this form: written reference on the front and rating form and brief comments on the back. Thank you.
NAME OF APPLICANT______
Name of Reference:______Date:______
Signature: ______Position______
Address:______
______Phone:______
*Please place this completed form in a sealed and signed envelope and return it to the applicant.
PLEASE CIRCLE THE NUMBER FOR EACH ITEM THAT BEST INDICATES YOUR ASSESSMENT OF THE APPLICANT. THE SCALE RANGES FROM 5 (HIGH—OUTSTANDING ABILITY) TO 1 (DEFINITE LIMITATION).
HIGH LOW NOT
OBSERVED
1. Speaks effectively 5 4 3 2 1 ____
2 . Writes effectively 5 4 3 2 1 ____
Comments:
3. Works well with colleagues 5 4 3 2 1 ____
4. Works well with persons 5 4 3 2 1 ____
from diverse backgrounds
5. Relates well with 5 4 3 2 1 ____
students
6. Relates well with 5 4 3 2 1 ____
families of students
Comments
7. Teaches effectively 5 4 3 2 1 ____
8. Works independently 5 4 3 2 1 ____
9. Demonstrates intellectual 5 4 4 2 1 ____
curiosity
10. Works conscientiously 5 4 3 2 1 ____
Comments
11. Handles stress well 5 4 3 2 1 ____
12. Adheres to ethical 5 4 3 2 1 ____
standards of behavior
13. Accepts 5 4 3 2 1 ____
extra responsibility
14. Shows ability to 5 4 3 2 1 ____
accept feedback
Comments
15. Shows leadership 5 4 3 2 1 ____
potential
Final Comments
EDUCATIONAL LEADERSHIP PROGRAM
CALIFORNIA STATE UNIVERSITY CHANNLE ISLANDS
Notification to the School District
The Educational Leadership Program at CSU Channel Islands works collaboratively with the school districts of Ventura County to prepare future school administrators for positions in leadership. The educator named below is making application to the Preliminary Administrative Service Credential Program. The applicant will be seeking two letters of recommendation from professionals who are familiar with the applicant’s work, at least one of whom is the applicant’s immediate supervising administrator. Once admitted, this educator will require assistance of a mentor who is an administrator in your school district. It is our intention, that working together we can select an excellent mentor to work with students preparing for positions of school leadership.
Candidate Complete This Section:
Name of Applicant for PASC credential:
School/site of applicant
Candidate’s preference for Mentor
School/site of suggested mentor
Mentor’s are appointed through collaboration between the district administrative representative to the Educational Leadership Program and the university director of the Educational Leadership Program.
Superintendent or District Representative to the Educational Leadership Program completes this section:
I am aware that the above named applicant may be admitted to the Educational Leadership Program at CSU Channel Islands and the district will be expected to collaborate in the preparation of this candidate by providing an administrative mentor for this individual.
Concern, if any
Confidential concerns may be addressed by calling the Educational Leadership Program Director at CSU Channel Islands at (805) 437-8573) or e-mail
Signature Date
Please print name
Phone E-mail
6
California State University Channel Islands Teaching Credential Program One University Drive, Camarillo, CA 93012 (805) 437-8953