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Teacher Education Program Application
Drury University
>
School of Education & Child Development
>
Teacher Education Program Application
Please enable JavaScript in your browser to complete this form.
Personal Information
Name
*
First
Last
Middle Initial
*
Maiden/former name(s)
Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
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Montana
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New Hampshire
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New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Home Phone Number
*
Cell Phone Number
*
Work Phone Number (optional)
Drury Email Address
*
Drury ID
*
Date of Birth
Additional Information
Choose the primary campus location where you attend classes
*
Ava
Cabool
St. Robert/Ft. Leonard Wood
Lebanon
Licking
Monett
Rolla
Springfield
Thayer
Are you a U.S. Citizen or permanent resident? (Choose one)
*
Yes
No
Ethnic Status (Optional, check all that apply)
African American
Asian American
Caucasian
Native American
Mexican American/Hispanic
Other
Classification (Choose one)
*
Freshman
Sophomore
Junior
Senior
Post-Baccalaureate
Area of Certification Desired
*
Elementary Education (Grades 1-6)
Middle School (grades 5-9)
Secondary (grades 9-12 or K-12)
Content Area
Language Arts
Mathematics
Social Studies
Science
Transcript Criminal Phone
Content Area
Art
Instrumental & Vocal Music
Language Arts
Mathematics
Physical Education
Social Studies
Science
Speech and Theater
World Languages
Criminal Record Check Release and Caregiver Background Screening Release
I agree to complete the criminal background check located at www.dhss.mo.gov/FCSR (required payment and processing fee). I understand that the Drury University School of Education and Child Development will have access to the results of the check that will indicate any arrests, reports of sexual abuse, family violence, or child abuse my record may contain. I also agree to release Drury University and its employees from future liability for any negligent act, omission, or fault arising from or related to this criminal record or background screeing check and any information contained in them. I do not, however, waive my rights to hold Drury University responsible for any harm caused by the intentional or grossly negligent conduct of its employees. I understand that Drury University will use the information obtained from this criminal record check and caregiver background check to determine my eligibility for admission to the Teacher Education Program. Drury's consideration of my application to the program is offered in exchange for this release.
I agree to the criminal record check release and caregiver background screening release
Transcript and Data Release
I authorize the Drury University Registrar to prepare copies of my undergraduate and graduate transcripts to be included in my School of Education and Child Development file. These transcripts will be used in determining my eligibility for admission to the Teacher Education Program and for advisory purposes by the Director of the School of Education and Child Development. I also understand that the School of Education and Child Development is required to report annual data to the U.S. Department of Education and the Missouri Department of Elementary and Secondary Education in accordance with Title II regulations. Information reported may include, and not be limited to, academic and demographic information (i.e. Social Security Number, standardized test results, gender, and ethnicity).
I agree to the transcript and data release
I understand that the School of Education and Child Development is required to report academic and demographic data
EDA (Educator Disposition Assessment)
I acknowledge that dispositions identified in The Educator Disposition Assessment (EDA) apply to the university setting, courses, early practicum experiences, and the final internship. I recognize that a strong correlation exists between the dispositions of teachers and the quality of their students’ learning. I know that teachers who care about their students and are willing to exert the effort needed to ensure the classroom is a productive learning environment, possess the professional dispositions outlined in the EDA. I am aware that my professional dispositions will be assessed throughout the teacher education program and will have a bearing on decisions made regarding eligibility to complete in a successful manner.
I understand and accept the information in the statement above regarding the content and purpose of the EDA (Educator Disposition Assessment)
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