VIRGINIA COMMONWEALTH UNIVERSITY

Metro READY: University-Community Partnerships to Prepare & Support

Early Intervention and Early Childhood Special Educators

in Urban Inclusive Settings

APPLICATION FOR PROGRAM ADMISSION

Please identify your current classification:

______I am enrolled in the Early Childhood Special Education (ECSE) M. Ed. Program at VCU.

______I am employed as an EI/ECSE teacher with a conditional license and am only seeking

endorsement in ECSE.

In addition to the completion of this application, each applicant must submit;

·  an official transcript from colleges or universities attended

·  two letters of reference

·  a copy of passing VCLA scores.

A. GENERAL INFORMATION Date _____/_____/_____

______

Name Daytime Phone

______

Street Address Evening Phone

______

City/State/Zip FAX#

______

Social Security # E-Mail

______

Place of Employment Position/Title

B. EDUCATIONAL BACKGROUND

Institution / Major / Degree/Year / Grade Point Average

C. PLEASE ANSWER THE FOLLOWING QUESTIONS IN THE SPACE PROVIDED:

1. How did you learn about the Metro READY program?

2. Describe your previous experience with young children and

individuals with disabilities and their families.

APPLICATION FOR Project Metro READY

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3. What are your professional career goals and where do you see yourself in 5 to 10 years?

4. In regards to providing family-centered, culturally responsive quality services to infants and

young children with disabilities and their families, please describe your interests, strengths,

and limitations.

5. Describe your collaborative and consultative experiences in inclusive settings.

Please send all information to:

Belinda Hooper, Virginia Commonwealth University, Box 842020, Richmond, VA 23284-2020

VCU is committed to enabling all individuals to participate in and benefit from all instruction and services to the maximum extent possible. If you require accommodations of any type to enable you to benefit from or complete this application, please notify us so that alternative formats may be made available. This program is committed to developing strategies to avoid barriers that can impede participation. VCU is an equal opportunity/affirmative action university and does not discriminate on the basis of race, gender, age, religion, ethnic origin, or disability.

For more information contact Dr. Evelyn Reed-Victor at (804) 827-2653 or Belinda Hooper at (804) 827-2663.