School of Education

Student ID#:

First Name:

Last Name:

Address:

Street Address

Street Address Line 2

CityState

Zip Code

Mobile Phone:

Area CodePhone Number

Park E-mail

Alternate E-mail

example@example.com

Year of High School Graduation:

Check any degrees you have earned:

Degree Granting Institution(s):

Park Program of Study:

Middle School Certification Area

Secondary Education Certification Area

K-12 Education Certification Area

When do you plan to student teach?

Please check the boxes to confirm understanding of each admission requirement. Applications will not be considered until all of these items are met or provided to the SOE.

Background Clearance Questions

These same questions appear on the DESE initial certification application. Answering "yes" to these questions will not immediately disqualify your application, however, additional information may be requested.

After a review of your criminal history background check, you may be denied admission. Upon request, Park University will provide you a copy of your criminal history background report received and you are entitled to challenge the accuracy and completeness of any information contained in the report.

Have you ever been charged with, convicted or entered a plea, including a plea of noto contendere, to any felony or misdemeanor whether or not sentence was imposed or suspended, except minor traffic violations?

If yes, explain fully.

Have you ever been denied a professional license, certificate, permit, credential, endorsement, or registration?

If yes, explain fully.

Has your professional license (except for driver’s license), certificate, permit, credential, endorsement, or registration ever been disciplined, suspended, revoked, reprimanded, restricted, curtailed or voluntarily surrendered or do you have any pending complaints before any regulatory board or agency or is there any investigation or adverse action now pending against you?

If yes, explain fully.

Have you ever resigned, been restricted, disciplined, or discharged from any position, including the armed forces, while under suspicion of having engaged in criminal, immoral, unethical behavior or unprofessional conduct, or are you under investigation for any such charge?

If yes, explain fully.

Attached a completed GPA Calculation Spreadsheet to calculate your content GPA. Spreadsheet can be found in MyPark under School of Education resources.

Upload a File

Upload a professional photo of yourself. (A selfie is acceptable - but this photo will help faculty recognize you if they haven't had you in class. Keep that in mind.)

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Date

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School of Education

Admission Requirements