ACT application

Accelerated Collaborative Teacher (ACT) Preparation Program

Application for Multiple Subject, Single Subject, or Education Specialist Credential Candidates
ACT Application for:
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Phone Number

Area CodePhone Number
Other Phone Number

Area CodePhone Number
CSUN ID Number
Social Security Number
Gender
Age
Ethnic Identity
Other Ethnic Identity (specify)
Languages in which you are fluent
Undergraduate Major
Institution & Date
Undergraduate GPA (please specify)
Have you submitted a CSUN application through CSUMentor?
If yes, have you been accepted?
Have you submitted a credential application?
If yes, have you been accepted?
Have you met the writing proficiency requirement (course or exam)?
Complete the appropriate section
Elementary Education
Have you met the Basic Skills Requirement (CBEST or CSET MS Exam plus CSET Writing Exam)
Have you met the subject matter requirement (CSET)?
Secondary Education
Academic Major
Have you met the Basic Skills requirement (CBEST)?
Have you met the Subject Matter requirement
If yes, please indicate how this requirement was met:
Special Education
Have you met the Basic Skills Requirement (CBEST or CSET MS Exam plus CSET Writing Exam)
Have you met the Subject Matter requirement
If yes, please indicate how this requirement was met:
Your responses to these questions are used in consideration for admission to the program. Please reflect and write carefully.
1. What experiences have you had with school age children or adolescents?
2. What qualities/attributes do you have that would contribute to becoming a successful teacher?
3. How did you hear about the program?
Signature of applicant (Type name and add date for electronic submission)
Date/Time

MonthDayYearHourMinutesAM/PM Option
Should be Empty:

Accelerated Collaborative Teacher (ACT) Preparation Program

Complete the appropriate section

Elementary Education

Secondary Education

Special Education

Your responses to these questions are used in consideration for admission to the program. Please reflect and write carefully.