School of Education - University of Rhode Island

Application Form
School of Education - Teacher Education Program

Please complete the following:
1. Name & ID:	First Name Last Name URI ID
For each address and phone number below, please indicate your preference for the order in which we use these, using 1 for the address or phone number you wish us to use first, and 2 for your second priority address and phone number.
2. Permanent Address:	Street Address Preference City State Zip
3. Local Address:	Street Address Preference City State Zip
4. Phones:	Permanent Home Preference Local Home Preference Cell Preference
5. E-mail addresses:	School Preference Personal Preference
6. Academic Status:	How many credits will you have completed at the end of this semester? GPA (Overall) GPA (Major or specialization) (Secondary and music applicants only)
7. Academic Program:	Area of expected certification: Level:
	Secondary applicants only: Please check intended specialty area(s): English Biology Chemistry Mathematics Physics History and Social Studies General Science Spanish Italian French Latin German Chinese Please specify the year in which you anticipate student teaching. Spring
	Elementary and Secondary applicants only: I am interested in the Middle School Endorsement Program, which expands my certification to allow me to teach in RI Middle Schools (grades 5-8).
	All applicants: I am interested in the English as a Second Language Endorsement.
	Master's in Special Education Early Childhood and Elementary applicants only: I am interested in applying concurrently to the Master's in Special Education Program (elementary and middle school level, K-8 certification). Secondary applicants only: I am interested in applying concurrently to the Master's in Special Education Program (middle and high school level, 7-12 certification).
* Competitive admissions means that a limited number of positions are available in Teacher Education Programs and that some qualified applicants may be denied admission. A faculty committee reviews all applications.
Signature:	The information on this application is complete and accurate to the best of my knowledge. Please type your full name as your electronic signature Date:
The information below is requested but not required. This self-identification will be used only to describe our student body and for our program evaluation purposes.
Date of birth , Gender Cultural Background Hispanic

The University of Rhode Island is an affirmative action and equal opportunity employer.