Fillable PK3CT Admission Paperwork 2 (Louisiana State University)

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PK3CT Admission Paperwork 2 (Louisiana State University)

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Application for Admission:
Early Childhood Education (Grades PK-3)
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:
Minor:
(Minors are not required for this major.)
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 re-
quirement 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 2.5 cumulative GPA to enroll in 3000/4000-level education classes and to
student teach. 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
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 Univer-
sity/College rules. The HSE counselor is obligated to break confidentiality when there is indication of potential harm to the stu-
dent 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
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 quali-
fied 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 pursuing a
teacher education program, I will report this change to the Office of Student Services.
I understand and agree to the infor-
mation 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
PK3CT Admission Application: FOR OFFICE USE ONLY
Hours Earned:
 24+ hours
GPA - 2.5 LSU/Cum required:
 LSU:
 Cum:
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 1029 or 1021
 2.0 LSU/Cum GPA
Semester 2:
 “C”+ in MATH 1029 or 1021 or
1201
 2.0 LSU/Cum GPA
Semester 3:
 “C”+ in MATH 1029 or 1201
 “C”+ in EDCI 2081
 2.3 LSU/Cum GPA
Semester 4:
 “C”+ in ENGL 2000
 “C”+ in MATH 1202
 2.5 LSU/Cum GPA
 Admission into HSE
Semester 5:
 “C”+ in ELRC 2507
 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 1029 or 1021
 2.0 LSU/Cum GPA
Semester 2:
 “C”+ in MATH 1029 or 1021
or 1201
 2.0 LSU/Cum GPA
Semester 3:
 “C”+ in MATH 1029 or 1201
 “C”+ in EDCI 2081
 2.3 LSU/Cum GPA
Semester 4:
 “C”+ in ENGL 2000
 “C”+ in MATH 1202
 2.5 LSU/Cum GPA
 Admission into HSE
Semester 5:
 “C”+ in ELRC 2507
 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 1029 or 1021
 2.0 LSU/Cum GPA
Semester 2:
 “C”+ in MATH 1029 or 1021
or 1201
 2.0 LSU/Cum GPA
Semester 3:
 “C”+ in MATH 1029 or 1201
 “C”+ in EDCI 2081
 2.3 LSU/Cum GPA
Semester 4:
 “C”+ in ENGL 2000
 “C”+ in MATH 1202
 2.5 LSU/Cum GPA
 Admission into HSE
Semester 5:
 “C”+ in ELRC 2507
 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 1029 or 1021
 2.0 LSU/Cum GPA
Semester 2:
 “C”+ in MATH 1029 or 1021 or
1201
 2.0 LSU/Cum GPA
Semester 3:
 “C”+ in MATH 1029 or 1201
 “C”+ in EDCI 2081
 2.3 LSU/Cum GPA
Semester 4:
 “C”+ in ENGL 2000
 “C”+ in MATH 1202
 2.5 LSU/Cum GPA
 Admission into HSE
Semester 5:
 “C”+ in ELRC 2507
 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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