Fillable HPE Admission Paperwork 2 (Louisiana State University)

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HPE Admission Paperwork 2 (Louisiana State University)

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Application for Admission:
Health & PE
Please print the following information:
Name:
Last First Middle
LSU ID: 89 - - E-mail Address: Phone #:
Semester Enrolling in the College of Human Sciences & Education:
Statement of HSE Student Expectations
Please read, sign, and date:
The College of Human Sciences & Education has high expectations of its students. Each student is responsible for learning
and completing all of his/her degree requirements. Additionally, students are responsible for knowing and complying with all
University and College rules, regulations, and deadlines. Ignorance of a requirement or rule is not grounds for waiving that
requirement or rule. Students can obtain information on degree requirements, University regulations, and College regulations
in the LSU General Catalog (http://www.lsu.edu/catalogs/).
I understand that I must have a 2.5 LSU GPA and a 2.5 cumulative GPA to enroll in 3000/4000-level education classes and
to student teach. I understand that I must pass the PRAXIS I Pre-Professional Skills Tests (Reading, Writing, and Math) if
taken prior to September 1, 2014, the PRAXIS Core Academic Skills for Educators Tests (Reading, Writing, and Math) if
taken on or after September 1, 2014, or have an official ACT/SAT composite score of 22/1030 or higher on record with LSU
before enrolling in 3000/4000-level education courses. I must pass all required PRAXIS II assessments to graduate and be
certified in teacher education.
Student Signature Date
DATA
FOLDER
Minor:
(Minors are not required for this major.)
Fall 20 Spring 20 Summer 20
Last Update 12/2015
Statement of Confidentiality
Please read, sign, and date:
When working with an HSE counselor, the student's right to privacy is guarded as much as permitted by law, ethics and
University/College rules. The HSE counselor is obligated to break confidentiality when there is indication of potential harm
to the student or others, concern of neglect or abuse, a court of law requires testimony or student records, or as required by
university policies. The HSE counselor often consults with other college professionals but only shares information necessary to
achieving the goals of the consultation. I understand and agree to the information above.
Student Signature Date
Continued
DATA
FOLDER
Last Update 12/2015
Teacher Education Student Self-Evaluation
Please read, sign, and date:
The teaching profession, along with other professions, has the responsibility to ensure that the welfare of society is
safeguarded and enhanced. Consequently, no person should be allowed to enter the teaching profession whose actions or
failure of performance will result in a materially adverse effect upon children in the school system. Therefore, the College of
Human Sciences & Education reserves the right to admit and retain in teacher education programs only those students
qualified to work with children. Teacher education students are required to complete the attached Professional Conduct
Form, which is based on the form required for certification by the Louisiana State Department of Education.
Should there
be any change in my status as listed on this form or any other change affecting my teacher qualifications while I am pur-
suing a teacher education program, I will report this change to the Office of Student Services.
I understand and agree to
the information above.
Student Signature Date
Continued
Student Teaching and Accommodations
Please read, sign, and date:
Students with identified disabilities should alert the Office of Field Experiences PRIOR to submitting a student teaching
application. Documentation of the student’s disability, provided by LSU’s Disability Services, must be received by the Office
of Field Experiences before accommodations will be made. Students should note that accommodations that are typically
given in content courses may not be applicable during field placements for student teaching. The appropriateness of
accommodations will be discussed during a meeting between Disability Services staff, the student, and Office of Field
Experiences.
Student Signature Date
Teacher Education Professional Conduct Form
Please print the following information:
Name: LSU ID: 89 - -
Last First Middle
Last Update 12/2015
The teaching profession, along with other professions, has the responsibility to ensure that the welfare of society is safeguarded and enhanced.
Consequently, no person should be allowed to enter the teaching profession whose actions or failure of performance will result in a materially
adverse effect upon children in the school system. Therefore, the College of Human Sciences & Education reserves the right to admit and
retain in teacher education programs only those students qualified to work with children. Teacher education students are required to complete
this Professional Conduct Form, which is based on the form required for certification by the Louisiana State Department of Education.
Students who answer “YES” to any question below will be contacted as they will need to explore their certification eligibility with the
Louisiana Department of Education.
Should there be any change in a student’s status as listed on this form or any other change affecting
their teacher qualifications while pursuing a teacher education program, the student is required to report this change to the Office of
Student Services, 236 Peabody Hall.
Each question must be answered.
Please Check
Yes No
1. Have you ever been refused admission or dropped from a teacher education program at this
institution or any other college or university?
If YES, at which institution?
2. Have you ever had any professional license/certificate denied, suspended, revoked, or voluntarily
surrendered?
If YES, in which state?
3.
Are you currently being reviewed/investigated or is such action pending for situations described in
questions #1 or #2?
If YES, at which institution/state?
4.
Have you ever been convicted of, found guilty of, or pled nolo contendere (no contest) to a felony
offense, even if adjudication was withheld?
If YES, please provide the following information:
Date of conviction:
State of conviction: Court of Jurisdiction of Conviction:
5. Have you ever been convicted of a misdemeanor offense that involves any of the following:
A. Sexual or physical abuse of a minor child or other illegal conduct with a minor child.
B. The possession, use, or distribution of any illegal drug as defined by Louisiana or federal
law.
6.
Have you ever been granted a pardon or expungement for any offense as stated in #4 or #5?
I certify that I have answered these questions to the best of my knowledge. Further, should there be any change in my status
as described above or any other change affecting my teacher qualifications while I am pursuing a teacher education program,
I will report this change to the Office of Student Services, 236 Peabody Hall, immediately.
Student Signature Date
Staff Initials Date
Last Update 12/2015
HPECRT Admission Application: FOR OFFICE USE ONLY
Hours Earned:
 24+ hours
GPA - 2.5 LSU/Cum required:
 LSU:
 Cum:
C or better in the following courses:
 ENGL 1001:
 MATH 1021:
 MATH 1022:
 BIOL 1201:
 BIOL 1202:
ACT/SAT Score:
 ACT Score:
 SAT Score:
 No scores on file
Praxis I/PRAXIS Core
 Reading (176/156)
 Writing (175/162)
 Math (175/150)
 Meets PRAXIS I waiver based on
ACT/SAT scores
Classification Code:
Minor:

 N/A
Catalog Year:
 2012-2013
 2013-2014
 2014-2015
 2015-2016
 2016-2017
 Other:
Semester Entered:
 1s/
 2s/
 3s/
Mainframe Updates:
 UPGM
 UCOM
Date Entered: By:
Transferred From:
 UCFY
 UCAC
 Other:
Date Processed: By:
HSE Handbook:
 Sent via email:
COMPREHENSIVE ACADEMIC TRACKING SYSTEM
Current Tracking
 Tracking Semester:
 Semester off Track:
 Comments:
2012-2013 Catalog
Semester 1:
 “C”+ in ENGL 1001
 “C”+ in MATH 1021
 2.2 LSU/Cum GPA
Semester 2:
 “C”+ in MATH 1022
 2.3 LSU/Cum GPA
Semester 3:
 “C”+ in BIOL 1201
 2.4 LSU/Cum GPA
Semester 4:
 “C”+ in BIOL 1202
 “C”+ in KIN 2504
 2.5 LSU/Cum GPA
 Admission in HSE
Semester 5:
 “C”+ in ENGL 2000
 “C” in KIN 2500
 2.5 LSU/Cum GPA
Semester 6-8:
 2.5 LSU/Cum GPA
2013-2014 Catalog
Semester 1:
 “C”+ in ENGL 1001
 “C”+ in MATH 1021
 2.2 LSU/Cum GPA
Semester 2:
 “C”+ in MATH 1022
 2.3 LSU/Cum GPA
Semester 3:
 “C”+ in BIOL 1201
 2.4 LSU/Cum GPA
Semester 4:
 “C”+ in BIOL 1202
 “C”+ in KIN 2504
 2.5 LSU/Cum GPA
 Admission in HSE
Semester 5:
 “C”+ in ENGL 2000
 “C” in KIN 2500
 2.5 LSU/Cum GPA
Semester 6-8:
 2.5 LSU/Cum GPA
2014-2015 Catalog
Semester 1:
 “C”+ in ENGL 1001
 “C”+ in MATH 1021
 2.2 LSU/Cum GPA
Semester 2:
 “C”+ in MATH 1022
 2.3 LSU/Cum GPA
Semester 3:
 “C”+ in BIOL 1201
 2.4 LSU/Cum GPA
Semester 4:
 “C”+ in BIOL 1202
 “C”+ in KIN 2504
 2.5 LSU/Cum GPA
 Admission in HSE
Semester 5:
 “C”+ in ENGL 2000
 “C” in KIN 2500
 2.5 LSU/Cum GPA
Semester 6-8:
 2.5 LSU/Cum GPA
2015-2016 Catalog
Semester 1:
 “C”+ in ENGL 1001
 “C”+ in MATH 1021
 2.2 LSU/Cum GPA
Semester 2:
 “C”+ in MATH 1022
 2.3 LSU/Cum GPA
Semester 3:
 “C”+ in BIOL 1201
 2.4 LSU/Cum GPA
Semester 4:
 “C”+ in BIOL 1202
 “C”+ in KIN 2504
 2.5 LSU/Cum GPA
 Admission in HSE
Semester 5:
 “C”+ in ENGL 2000
 “C” in KIN 2500
 2.5 LSU/Cum GPA
Semester 6-8:
 2.5 LSU/Cum GPA
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Completed 20 July 2020

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