Application to Teacher Education Curriculum and Instruction Department School of Education Please complete the entire form prior to submitting this application. The application will not be processed until it is complete.

Name ID# Date

Address Telephone

Academic Major Religious Affiliation

Prerequisites:

Provide the following:

·	Copy of passing CBEST (California Basic Education Skills Test) Score	q
·	Copy of Certificate of Clearance with CCTC (California Commision for Teacher Credentialling)	q
·	Copy of Completion of Liberal Studies Major or appropriate qualifying test results	q
	Elementary: State approved Liberal Studies Major or MSAT if you are not a liberal studies major but plan to teach Elementary school
	Secondary: PRAXIS and SSAT or give dates you will takes the tests ______________________________
·	Copy of official undergraduate transcipts (and graduate transcripts if applicable)	q
·	Total Units completed in undergraduate major _____	q
·	GPA of 2.75 or above in undergraduate program	q
·	Verification of negative TB (tuberculosis) test from local Health Department or Physician	q
·	EDCI 204 Teaching in the Multicultural Classroom (C or above)	q
·	EDFO 305 Psychological Foundations of Education passed (C or above)	q
·	Pass the Basic Computer Examination of General Knowledge and Skills	q

Credential Sought: (Check all that apply)
California Single Subject	q	please state subject area for desired credential____________________
California Multiple Subject	q
SDA Teaching Credential	q
Experiences: List specific experiences with children or youth that you have had.
Complete and Mail this document with appropriate documents to: La Sierra University School of Education Office of Curriculum and Instruction 4700 Pierce St. Riverside, CA 92515

This Box For Department Use Only

Curriculum & Instruction Department Secretary’s Signature for above items   _______________________

Curriculum and Instruction Committee Action: Accepted q Denied q Hold q

Date Chair's Signature