Fillable Educator Preparation Institute Student Data Form (Eastern Florida State College)

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Educator Preparation Institute Student Data Form (Eastern Florida State College)

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The Educator Preparation Institute Student Data Form (Eastern Florida State College) form is 1 page long and contains:

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Country of origin: US
File type: PDF

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Educator Preparation Institute
Student Data Form
(Please fill out and save for emailing or print and mail)
Date__________
Last Name__________________________ First Name____________________ M.I.________________
Last 4 digits of SSI_________________________ Date of Birth__________________________________
Address___________________________________________________________ Apartment #________
City________________________________ State________________________ Zip__________________
Phone #________________________ Email_________________________________________________
1. What is your degree and subject area?
Bachelor’s_____________________
Master’s______________________
Doctorate_____________________
2. What Grade level do you plan to teach or are presently teaching?
☐ ECE (P-3) ☐ Elementary (K-6) ☐ Middle School (7-8) Subject Area______________
☐ High School (9-12) Subject Area____________________________________
Name of school (if presently teaching) __________________________________
3. How did you hear about the Educator Preparation Institute?
☐ Another Student ☐ Teacher
☐ Advisor
☐ Presentation ☐ News article ☐ Poster
☐ Brochure ☐ Website ☐ Other_____________
4. Did you complete an application to the Florida Department of Education for a Temporary
Certificate? (questions 5 and 6 also apply to this process) ☐ Yes ☐ No
5. Did you receive a Statement of Status of Eligibility from Florida DOE? ☐ Yes ☐ No
6. Does that statement indicate eligible or not eligible?_____________________________
7. In which county are you planning to teach?____________________________________
8. Which FTCE exams have you passed?
☐ Subject Area in your area of certification
☐ General Knowledge (math, reading, language arts, writing)
☐ Professional Education
Please note: when completing the field experience for each class it must be done in a classroom where:
1) the teacher is certified in the same subject area in which the EPI student is seeking certification and
2) the subject being taught and grade level match the subject and grade level on the Statement of Eligibility.
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Educator Preparation Institute Student Data Form (Eastern Florida State College)

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Completed 15 August 2020

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