Peer Review Project

For Early Childhood Educator Licensure

Due December 15, 2017

A P P L I C A T I O N

NOTE: This is a fillable form. You can type in the gray boxes as much information as needed. It may adjust the page layout if you extend into an additional line. You can save this document and email it with the other required documents to You can also print and mail any documents (see address below). Incomplete applications will not be considered.

Name / Date
Home Address
County / BFIS Q and C # (if known)
Home Telephone / Work Telephone
E-mail / Cell Phone

Relevant Work Experience: To apply for this project you must have at least 3 years of experience working with young children. Please list all experiences working with young children starting with the most recent. Please note* this program is for those working in private community-based early childhood settings.

Position Employer and Town Dates of employment

Educational Background: To qualify for this project you must have a Bachelor Degree with a final GPA of at least 3.0 Please list your college education experiences starting with the most recent.

College attended Major G.P.A. Degree earned Dates attended

Licensure Status

1.  Do you have a current Vermont Educator or Provisional Educator license? YES NO

2.  If yes, Level Endorsement area Renewal or Expiration date

3.  Have you ever held an educator license from Vermont or another state? YES NO

4.  If yes, which state? Endorsement area Date expired

5.  Have you passed the Praxis Core (Vermont’s educator testing requirement)? YES NO (If YES please skip question 6)

6.  Do you meet any of the following criteria?

·  I have taken Praxis ONE and have passing scores equal or higher than the following scores: Reading- 177; Writing -174;Mathematics 175 OR Combined score – 526. YES NO

·  I have qualifying SAT scores of combined score of 1000 and minimum Verbal (420) and Math (470) scores if taken before April 1, 1995 or combined score of 1100; or If taken after April 1, 1995 minimum Verbal (500) and Math (500). YES NO

·  I have qualifying ACT scores: English 22, Math 22. YES NO

·  I do not currently meet any of the above requirements and I will need to take Praxis Core before applying to the state of Vermont for Peer Review. YES NO

7.  Have you worked with young children with guidance from a supervising or mentor teacher/director who has a Vermont Educator license with an endorsement in ECE or ECESE?

YES NO

8.  Have you ever been recommended for licensure from an institution of higher education?

YES NO

11. Do you have regular access to the updated technology needed (computer, internet, and e-mail) to complete the online component of this course? YES NO

12. You will need to create an online portfolio or website as part of the Peer Review process. Do you feel you can complete this work with some guidance? YES NO

10. Have you previously participated in Transcript Review? YES NO

11. Have you previously participated in Peer Review? YES NO

12. Have you participated in a Peer Review clinic offered by the Vermont Department of Education?

YES - Date: NO

13. Do you have a Northern Lights early childhood level certificate? YES NO DON’T KNOW

If YES, which level? (I, II, III, IV, V)

14. Why are you interested in obtaining licensure at this time?

15. Please label and send the following additional documents (a-e):

a) Short essay: The Peer Review process requires strong writing and organizational skills, an ability to manage time and a capacity to work independently. Please describe a professional achievement or challenge that you believe demonstrates your ability to successfully complete the peer review process. (Should be approximately 500 words)

b) Copy of all college transcripts (copies are accepted for this application)

c) List or print from your BFIS account important professional development activities not listed in your transcript such as workshops, conferences, in-services. An approximate list of your most significant training accomplishments is fine—you will develop a more exact list when you begin working on your portfolio.

d) References: List contact information (name, e-mail, phone number and professional affiliation) from 2 professionals that can address your ability to successfully complete this project.

e) Attach a current resume

16. I have read the Peer Review Project Handbook YES

If after reading the handbook you have Questions

please contact Sherry Carlson at

Please send all documents by December 15th either by email to or by mail to:

Sherry Carlson; Northern Lights - 380 Round Barn Road; Ferrisburgh,Vermont, 05456

If you send some by email and others by mail, please indicate this clearly.

PRP Application 2015 3