College of Education and Counseling Teacher Certification Program Application

Before You Begin

Take a look at the requirements below:
College of Education and Counseling Teacher Certification Program Application

* INDICATES REQUIRED INFORMATION

* Fingerprinting Requirements
- Date of Fingerprints
- Uploadable copy of the Fingerprint Receipt.
- Learn more about Fingerprinting
* Pre-Residency Clearance Requirements
- OSPI Account must be created (Pre-Residency Clearance Instructions)
- Date the Pre-Residency Clearance was completed.
* Exam Requirements
- Date ot the WEST-B Exam (WEST-B Information)
- Or SAT Exam taken after 2005
- Or ACT Exam
* Pre-Program Observation
- Information Regarding Pre-Program Observations
  - 10 hours working with children ages 6-12
  - 10 hours working with children ages 13-18
  - 10 hours working in a K-12 school setting
- Pre-Program Observation Fields
  - Type of Experience (What you did)
  - Where or how you gained the experience
  - Supervisors Name (or N/A)
  - Start Date
  - Total Hours
  - Total Weeks
* Recommendation Questionnaire

We suggest that you ask your recommenders before submitting this documentation. Once you submit this form, they will recieve an email with the questionnaire and documentation they need to fill out. Two Recommendation Questionnaires will be required.

Additional Information

CPR / First Aid are recommended however not required. For further information on CPR / First Aid click here.

If you have taken courses at a different college/university, you will need to send an official copy to the Registrar's Office to recieve transfer credit.

Personal Information
Name*

First NameMiddle NameLast Name
Preferred Name or Nickname
Former Last Name
Date Of Birth*

MonthDayYear
Date
Last 4 SSN*

Address
Permanent / Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Same as above addressDifferent Address
Campus / Local Residential Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number
Contact by SMS*

YesNo
Mobile Number
Please enter a valid phone number.
Alternate Number
Please enter a valid phone number.

Saint Martin's / Email Information
Are you a current student at SMU?*

YesNo
SMU Student Number*
P000004517
SMU Email*
example@stmartin.edu
Personal Email*
This email address should not be your Saint Martin's email address. This is used as alternative contact information.
Work Email
example@example.com

International Students
Are you an International Student?*

YesNo
If yes, please enter VISA information:*
If yes, please enter TOEFL scores:*

IPEDS Data Collecting
Citizenship*
Country of Birth*
Gender*
First Generation College
First Language not English
Ethnicity*
Race One*
Race Two
Veteran Status
Religious Preference

Program Information

Please choose your program.
Choose Semester (To Start Program)*
Semester Year (To Start Program)*
This year or next I.E. 2022
Program of Interest*
Campus*
Area of Focus*
Primary Endorsement*
Secondary Endorsement

Educational History
Please list all institutions of higher education that you have attended prior or are currently attending (including Saint Martin's University).
How many colleges / universities have you attended?*

1234I have not attended any other colleges/universitiesOther
If other, please explain.*
College / University 1

Institution Name

Major / Minor

DegreeYears Attended (EX. F15 - SP 16)

GPA
College / University 2

Institution Name

Major / Minor

DegreeYears Attended (EX. F15 - SP 16)

GPA
College / University 3

Institution Name

Major / Minor

DegreeYears Attended (EX. F15 - SP 16)

GPA
College / University 4

Institution Name

Major / Minor

DegreeYears Attended (EX. F15 - SP 16)

GPA

Fingerprinting and Pre-Residency Clearance Certificate Agreement

Please Sign
Please read carefully and sign below.

If you have not had your fingerprinting completed please use the link below to set an appointment. You will need a copy of the fingerprinting reciept for this application. Please contact the certification specialist with any questions: education@stmartin.edu.

ESD (Fingerprinting information)

If you have not yet created your OSPI account and recieved your Pre-Residency Clearacnce, please follow the links below. You will need the date of the Pre-Residency clearance for this application. Your application cannot be processed until your fingerprints have cleared.

Pre-Residency Clearance Instructions

OSPI eCertification website

I am aware that:
- I must get fingerprinted by Educational Service District (ESD).
- I must start the WSP fingerprint background check before acceptance into the College of Education and Counseling.
- Your pre-residency clearance application cannot be processed until your fingerprints have cleared.
- I must be cleared by the Washington State Patrol (WSP) before I can begin any practicums and internships.
- Results from the fingerprint process may take three to four weeks to clear.
- Blurred prints or other circumstances may delay the clearance process or necessitate that I return to the office to have the redone.
- The fingerprint background check is valid for TWO YEARS from the WSP clearance date and must be renewed every two years.
- If prints expire during the program you will need to get reprinted ASAP.
- I must obtain Pre-Residency Certificate Clearance from the Office of Superintendent of Public Instruction (OSPI) for the State of Washington before I can begin my student internship.
- Completion of Saint Martin's University teacher education/school counselor/master's program does not guarantee certification.
- Any falsification or deliberate misrepresentation, including omission of a material fact, in completing the pre-Residency Certificate Clearance can be grounds for Saint Martin's University non-recommendation and/or OSPI denial of certification.
Full Name*

First NameLast Name
Signature*

Clear
Date*

Required Fingerprint Documentation
Fingerprinting Documentation Upload.

Fingerprints must be done at an Educational Service District (ESD). Please list the date of which you had your fingerprints done below. If you have your fingerprinting receipt, please upload it in the space provided.

Note: Fingerprints are valid for two years after the WSP clearance date, at which point they will need to be renewed. By submitting this application, you certify that you understand that these fingerprints will need to be renewed two years past the clearance date if you are still in our program.
Fingerprinting Date*

MonthDayYear
Date
Please attach a copy of the fingerprinting receipt.*

Cancelof

Required Pre-Residency Information
Pre-Residency Clearance

Pre-Residency Clearance is required by the state of Washington for any Teacher Certification Candidate to be in a classroom. Pre-Residency Clearance must be completed through the OSPI eCertification website. The application only takes about 15 minutes, but it takes two days for OSPI to fully set up your account.

Pre-Residency Clearance Instructions

If you have questions, please feel free to contact education@stmartin.edu.
Pre-Residency Clearance Submission Date*

MonthDayYear
Date

Pre-Program Observation Requirements
This section is to document your experience working with children during the last 5 years. This will satisfy the pre-program K-12 observation requirements set forth by the State of Washington.

You Must have ALL of the following.
- 10 Hours of experience working with children ages 6-12
- 10 Hours of experience working with children ages 13-18
- 10 Hours of experience working in a K-12 setting

Required Pre-Program Observation Ages 6 - 12
10 Hours of Experience Working with Children Ages 6-12

Your Experience could take place within various groups/activities such as volunterring, tutoring, public or private school meetings, youth organizations, camps, sprots, or through a course taken at an accredited college or university.
Type of Experience (What you did):*
Where/how you gained the experience:*
Supervisor (if none use N/A)*
Start Date*

MonthDayYear
Date
Total Hours*
Total Weeks*

Required Pre-Program Observation Ages 13 - 18
10 Hours of Experience Working with Children Ages 13-18

Your Experience could take place within various groups/activities such as volunterring, tutoring, public or private school meetings, youth organizations, camps, sprots, or through a course taken at an accredited college or university.
Type of Experience (What you did):*
Where/how you gained the experience:*
Supervisor (if none use N/A)*
Start Date*

MonthDayYear
Date
Total Hours*
Total Weeks*

Required Pre-Program Observation Grades K - 12
10 Hours of Experience Working in a K-12 School Setting

Your Experience could take place within various groups/activities such as volunterring, tutoring, public or private school meetings, youth organizations, camps, sprots, or through a course taken at an accredited college or university.
Type of Experience (What you did):*
Where/how you gained the experience:*
Supervisor (if none use N/A)*
Start Date*

MonthDayYear
Date
Total Hours*
Total Weeks*

Pre-Program Observation Verification
Type a question*

Clear
Full Name*

First NameMiddle NameLast Name
Pre-Program Verification Date*

Optional CPR / First Aid
THIS IS NOW OPTIONAL AS OF FALL 2021

CPR/First Aid for Children and Adults

CPR/First Aid for Children and Adults is recommended for any student in certification track program. CPR/First Aid training can be obtained through a variety of venues including the American Red Cross, the American Heart Association, local fire departments, or here on the SMU campus.
CPR / First Aid class date

MonthDayYear
Date
File Upload

Cancelof

Emergency Contact
Name*
Relationship*
Phone Number*
Please enter a valid phone number.

Relatives Affiliated with Saint Martins' University
Relatives Name

NameRelationshipConnection to SMU
Relatives Name

NameRelationshipConnection to SMU
Relatives Name

NameRelationshipConnection to SMU

Recommendation Waiver
Confidential Recommendation Questionnaire

I hereby waive my right to read and review confidential statements of recommendation which are contained in, or are a part of, my application to the education program at Saint Martin's University. This waiver, which I understand that I am not obliged to sign, can only be revoked in writing and only with respect to confidential statements and questionnaires placed in my record subsequent to the written revocation.
Signature*

Clear
Waiver Date*

Recommendation Questionnaire Information

The questionnaire will automatically be sent to the recommenders.
If you haven't already reach out to the contacts listed below, please follow up with them to confirm that they are willing to complete the questionnaire. Once you submit this form, an automatic email will be sent to them with more information.
Recommender One - Name*

First NameLast Name
Request One Email*
example@example.com
Recommender Two - Name*

First NameLast Name
Request Two Email*
example@example.com

College of Education and Counseling Policy
I have read and understand the entire application. By signing below, I certify that all answers are true, correct, and complete. I agree to all stipulations and deadlines. I understand that false or misleading answers are cause for rejection of my application, or, if a violation is discovered after admission, I may be disqualified for scholarships, suspended, or expelled from the University, or have my conferred degree revoked.

If accepted to the program, I understand that my test scores and other application information will be released to state organizations for certification and program requirements as per state legislation.
Signature*

Clear
Full Name*

First NameMiddle NameLast Name
Date of Application*
Should be Empty:

Before You Begin

College of Education and Counseling Teacher Certification Program Application

Personal Information

Address

Phone Number

Saint Martin's / Email Information

International Students

IPEDS Data Collecting

Program Information

Educational History

Fingerprinting and Pre-Residency Clearance Certificate Agreement

Required Fingerprint Documentation

Required Pre-Residency Information

Required Exam Information

Pre-Program Observation Requirements

Required Pre-Program Observation Ages 6 - 12

Required Pre-Program Observation Ages 13 - 18

Required Pre-Program Observation Grades K - 12

Pre-Program Observation Verification

Optional CPR / First Aid

Emergency Contact

Relatives Affiliated with Saint Martins' University

Recommendation Waiver

Recommendation Questionnaire Information

College of Education and Counseling Policy