Revised 9/5/19
Personal Data
Name Student I.D.#
Last First Middle
Mailing Address Zip Code
P.O. Box/Street City State
Phone Number: (H) (W) (C)
Email Address: Primary Secondary
Are you a resident of the State of Hawaii? □Yes □No If not, state of residency
Gender: Male Female Ethnicity: Hispanic Non-Hispanic Race:
(Admission to the Master of Arts in Teaching is non-discriminatory. Due to various laws requiring statistical reports on ethnic origins of students, we ask the above
questions)
Application: Students must submit a UH Common Application form for admission into UH Hilo before submitting this Supplemental Application
form for the Master of Arts in Teaching Program.
Completion of Prerequisite and Content Preparation Courses: All prerequisite and content preparation courses must be completed prior to
entering the Master of Arts in Teaching Program.
Recommendation Form: Three (3) recommendation forms are required for each applicant. The forms should be obtained from someone who has
directly observed your performance and can address your potential in the education field.
Statements of Interest in Teaching and Beliefs about Student Learning
In your most polished and professional writing, please prepare two statements responding to the prompts described below. Each statement should be approximately 250
words, typed, double spaced, and submitted with this application.
Statement 1. Why do you want to be a teacher? Please describe what experiences motivated you to choose teaching as your profession over another career.
Statement 2. Please describe your beliefs about student learning. What has influenced you in those beliefs?
Experiences Working with School-Aged (P-20) Youth. Describe your experiences working with school-aged (P-20) youth with emphasis on the
target age level appropriate to the program for which you are applying. Examples of such experiences include volunteer tutoring, summer fun
programs, substitute teaching or employment as a teacher's aide. Where appropriate, include the name of the organization, supervisor, dates of
experience or employment and your duties. Please list experiences in chronological order starting with the most recent experience first. We reserve
the right to verify this information.
The Hawai'i State Department of Education requests information of applicants for teacher licensure and employment in the public schools of Hawai'i. The
DOE also verifies information through law enforcement agencies regarding sex-related offenses, child abuse/neglect/neglect offenses, substance/drug abuse
offenses, or any violation of the law (felony or misdemeanor) other than minor traffic violations. Applicants to the Master of Arts in Teaching Program
Cohort with concerns in any of these areas are encouraged to contact the Hawai'i DOE. Results of the background check may impact field placement in
schools which is a requirement of the Master of Arts in Teaching Program Cohort.
Signature: Date:
