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APPROVAL TO TAKE ANNOTATION AND EXTENSION GRADUATE COURSEWORK (Nazareth College)

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APPROVAL TO TAKE ANNOTATION AND EXTENSION
GRADUATE COURSEWORK AT NAZARETH COLLEGE
THANK YOU FOR YOUR INTEREST IN GRADUATE STUDIES AT NAZARETH COLLEGE! If you need assistance completing this
approval form, please email eduextension@naz.edu.
We will be happy to assist you in pursuing your educational goals.
PLEASE NOTE: Annotation and Extension Approvals are due at least two weeks before the start
of the term the student will begin taking coursework.
CRITERIA – PLEASE SUBMIT THE FOLLOWING
1. Completed Approval Form.
2. Copy of your teacher certification in Education. This is required for approval to take coursework in all of the extensions/annotations
offered.
3. Completion of the personal/professional statement describing your reasons for undertaking this particular annotation/extension.
4. See chart on page 3 for additional specific requirements.
APPROVAL FORM – To be approved to take annotation or extension coursework, please complete the following information:
1. Name
Last First Middle or Former Student ID Number
2. Address
Street/Apt. #/City/State/Zip
3. Telephone &
Email Home Phone Work Phone Cell Phone
Home Email Work Email
4. Employer If you are currently teaching, indicate the name and address of the school:
School Name School District
School Address School Phone
5. Certification
Teacher certification currently held Certification area and grade level
Check one: active pending lapsed
State Date Issued
6. What semester/year will you begin your annotation/extension coursework?
Fall 20 Spring 20 Summer I 20 Summer II 20
7. Indicate the Annotation or Extension to which you are applying:
Bilingual Extension: Please specify current area of certification:
Gifted and Talented Extension
Teaching Students with Severe or Multiple Disabilities Annotation
Students with Challenging Behaviors
ESOL Certification Only Program
School of Education
l
4245 East Avenue Rochester, NY 14618
l
Phone: (585) 389-2051
l
e-mail: eduextension@naz.edu
8. For Federal Reporting Purposes
Date of Birth: Gender: Male Female
1. What is your ethnicity? Not Hispanic or Latino Hispanic or Latino
2. What is your race? Mark one or more races to indicate what you consider yourself to be.
White Black or African American Asian American Indian or Alaskan Native Native Hawaiian or Other Pacific Islander
9. Previous College Information:
Colleges attended: Entering Date Leaving Date Degree Type GPA Date Conferred
10. PERSONAL/PROFESSIONAL STATEMENT – PLEASE ATTACH
An essential component of the approval process is a personal/professional statement describing your reasons for undertaking this
particular graduate annotation or extension. The personal/professional statement should include any information that will advance your
candidacy, e.g. personal and professional attributes and goals, volunteer and professional experiences related to the program to which
you are applying, and other related life experiences. You should also address your fut
ure academic plans and anticipated contributions to
the area of education for which the coursework will prepare you.
*See page 3 for ins
tructions for Bilingual Extension statements.
11. By signing below, I am confirming that the information I have provided for annotation/extension approval is true to the best
of my knowledge. I understand that misrepresentation of facts on this approval form will be cause for denial, cancellation, or
suspension from the institution. I agree to abide by the written policies and regulations of the institution and the regulations of
the New York State Education Department regarding teacher certificati
on. I understand that continuation in coursework in
subsequent semesters will be based on my academic and professional performance, and program director’s approval. My
continued matriculation is contingent upon completing 6 credit hours per calendar year.
SIGNATURE OF APPLICANT DATE
PLEASE RETURN COMPLETED FORM WITH YOUR MATERIALS TO: eduextension@naz.edu
Academic Support Services will send the form and documentation to the appropriate Program Director for review.
For Internal Use Only – Program Director Review
Approval form received – Date: Initials:
All materials present – Date: Initials:
Materials Missing:
Sent to program director – Date: Initials:
Approved for Annotation/Extension OR Not Approved for Annotation/Extension
Program approval sent to candidate – Date: Initials:
Approved First Term Coursework:___________________ ___________________________________________________________________________________________
Comments: ___________ _______________________________________________________________________________________________________________________ _________
____________________________________________________________________________________________________________________________________________
_______________________________________________________
__________________________
Program Director Signature Date
School of Education
l
4245 East Avenue Rochester, NY 14618
l
Phone: (585) 389-2051
l
e-mail: eduextension@naz.edu
Additional Annotation and Extension Information
Certification
Required
Additional Approval
Requirements
Annotation /Extension Courses
Required
Bilingual Extension*Dr. Cynthia McPhail, Program Director*Phone: (585) 389-2607*E-mail: cmcphai2@naz.edu
•
Early childhood,
childhood, middle
childhood,
adolescence,
special subject,
literacy education,
career and
technical
education,
students with
disabilities,
students who are
blind or visually
impaired, students
who are deaf or
hard of hearing, or
students with
speech and
language
disabilities
•
Rather than the personal statement in section 10 above, applicants
to the Bilingual Extension should write two, different
personal/professional statements: Each should be one-page, typed,
double spaced, 12 point font, with one inch margins. Select from
the topics below. One of your selected statements is to be written in
English, the other is to be written in Spanish. The choice as to
which topic will be addressed in each language is yours.
Please respond to the first topic:
1. Discuss how you might use the bilingual extension with your
current certification and how you might serve English language
learners.
You may select one of the following two topics:
1. What do you consider to be your two greatest strengths as a
teacher? How do these qualities nurture bilingual students?
2. Describe an experience you have had that reflects a Spanish
speaking culture
BIL640 – Teaching Content Areas in
Spanish Bilingual Classrooms (25 hours
fieldwork required)
BIL641 – Native Language Arts and
Literacy Instruction for Spanish
Speakers (25 hours fieldwork required)
TSL603 – Linguistics
TSL604 – Foundations of Bilingual
Multicultural Education
Gifted and Talented Extension*Dr. Kate DaBoll-Lavoie, Program Director*Phone: (585) 389-2618 *E-mail: kdaboll9@naz.edu
•
Any teacher
certification
•
Personal professional statement
GTE550 – Introduction to Gifted and
Talented Education (25 hours fieldwork
required)
GTE560 – Curriculum and Instruction for
Individuals with Gifts and Talents (25
hours fieldwork required)
GTE650 – Gifted Education in the
School Organization and Community
Severe or Multiple Disabilities Annotation *Dr. James Black, Program Director *Phone: (585) 389-2619 *E-mail: jblack8@naz.edu
•
Teacher
certification in
Students with
Disabilities
•
Personal professional statement
SMD650 – Seminar in Supporting
Students with Challenging Behavior in
Inclusive Settings
(25 hours fieldwork
required; course offered once per year)
SMD651 – Strategies for Breaking the
Conflict Cycle and Teaching Students
with Challenging Behaviors (25 hours
fieldwork required; course offered once per
year)
ESOL Certification Only *Dr. Rui Cheng, Program Director *Phone: (585) 389-2441 *E-mail: rcheng9@naz.edu
•
Any teacher
certification
•
Personal professional statement
•
An official transcript from the college where you completed your
highest degree
•
12-credits of a language other than English (and appropriate
documentation to accompany it)
TSL 603 – Linguistics (25 hours of
fieldwork)
TSL 604 – Foundations of Bilingual
Multicultural Education
TSL 605 – Culture and Context in
TESOL/Bilingual Curriculum and
Assessment
TSL 611 – Principles and Practices of
TESOL
(25 hours of fieldwork)
TSL 620 – Language and Literacy
Development for ELLs
TSL 635 – Practicum and Seminar in
TESOL
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APPROVAL TO TAKE ANNOTATION AND EXTENSION GRADUATE COURSEWORK (Nazareth College)

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Completed 1 February 2021

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