TESOL ENDORSEMENT PROGRAM in Partnership with Santa Fe Public Schools

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1 SANTA FE COMMUNITY COLLEGE TESOL ENDORSEMENT PROGRAM in Partnership with Santa Fe Public Schools APPLICATION PACKET TESOL Certificate for Licensed Teachers seeking a TESOL Endorsement The complete TESOL Endorsement Program Application packet should be submitted to Bethany Muller in the School of Education. Bethany Muller, Ph.D. Teacher Education 6401 Richards Avenue Santa Fe, NM

2 TEACHER ACADEMY TESOL Endorsement Program in Partnership with Santa Fe Public Schools APPLICATION CHECKLIST Submit an application for admission to Santa Fe Community College, only if you have never taken classes at SFCC before. The application can be accessed online at (click on online registration ). You may also enroll by clicking on the JACK icon, click First Time at SFCC and complete as instructed. If you have enrolled in courses at SFCC before, you will include your A number on the TESOL application. Note: Be sure to fill out this application as a credit student and not a continuing education student. a. Once you have applied to SFCC, you will be assigned an A number (SFCC student ID number). You will need this ID number to fill out your TESOL application and for course registration. Complete a TESOL Endorsement Program Application A copy of your Teaching License Signed Consent Form Disclosure Statement TESOL Scholarship Application Form (to receive your reimbursement checks and stipends) A signed Declaration of Major Form Include this cover page, with your signature and date, indicating that the application is complete. *Participants will take 6 TESOL credits (see below) and are required to pass the NMTA TESOL Exam. Additionally, participants will need to demonstrate 6 credits of a foreign language on a college transcript when applying for the endorsement with the PED. SFCC TESOL Courses EDUC 260 Language Learning and Teaching EDUC 262 TESOL *NOTE: EDUC 260 will be offered in fall 2012 on Tuesday evenings, from 5:30-8:00. I, (your name) _, have completed the TESOL application. I understand that upon successful completion of the TESOL coursework, I will earn a TESOL endorsement on my teaching license. If I do not complete the program or fail to make satisfactory academic progress, I understand that I will be liable for the full cost of tuition and books. Signature Date

3 SANTA FE COMMUNITY COLLEGE TEACHER ACADEMY TESOL ENDORSEMENT PROGRAM APPLICATION RETURN TO: Bethany Muller 6401 Richards Avenue Santa Fe, NM Phone: (505) Please complete this application on the computer, print, sign and mail it to the address above. Date: (1) Name (Last, First, Middle): (2) Other identifying name(s) which may appear on your documentation: (3) Mailing Address (Street, City, State, Zip Code): (4) Endorsement you are seeking: [ ] TESOL (K-8 Elementary) [ ] TESOL (7-12 Secondary) (5) A# (Student ID number): (6) Social Security Number: (7) Date of Birth: (8) Gender: (9) Home Phone: (10) Cell Phone: (11) Address (REQUIRED): (12) Fax Number (optional): (13) Name of school and district where you currently teach: (14) Grade level and subject you currently teach: (15) What percentage of your classroom is designated as English Language Learners? (16) Are you a U.S. Citizen? Yes No (17) If not, are you a resident alien with the right to work in this country? Yes No *If yes, attach proof of permanent residence to this application. (18) Are you fluent in a language other than English? Yes No (a) Please indicate the language. (19) Have you applied to the Santa Fe Community College Teacher Academy before?

4 Yes No (a) If yes, what was the date? (b) If yes, were you accepted, and to what program? Did you complete the program? (c) If yes and you did not complete the program, what was the reason? (20) Describe your philosophy of learning and teaching. (21) Why are you seeking a TESOL Endorsement? (22) Describe an intercultural experience you had or witnessed (e.g. traveling in a different country, watching two people from two different cultures interact). What did this teach you about intercultural communication? (23) Consider a teaching situation with an English Language Learner that you had or witnessed. Describe the situation and what you learned from it. (24) The following information is for reporting use only to provide statistical information requested by various State and Federal agencies: Ethnic Background: Circle one (optional) 01 White (non Hispanic) 02 African American (non Hispanic) 03 Hispanic 04 Asian, Pacific Islander, Oriental American 05 Native American or Alaskan Native

5 SANTA FE COMMUNITY COLLEGE TEACHER ACADEMY TESOL ENDORSEMENT PROGRAM CONSENT BY STUDENT FOR DISCLOSURE OF ACADEMIC INFORMATION I, hereby authorize Santa Fe Community College (SFCC) and the TESOL program staff to provide any information regarding my participation and/or progress in the SFCC TESOL program to (check all that apply): The school district (s) listed below: NM Public Education Department Licensure Unit for purposes of licensure/endorsement This information may include, but is not be limited to: name, social security number, student ID number, address, home telephone, work telephone, cellular, facsimile transmission, address, NMTA test score results, course schedule/registration, program enrollment/admissions status and information, transcript, payment authorization for third party payment by my employer, and details of progress through the Teacher Academy Program. This consent will expire six months after my completion of or withdrawal from the TESOL program, termination of my employment with the employer identified above, or upon my written notification to SFCC of termination and withdrawal of consent. I agree to notify the SFCC TESOL program Director of termination of employment and termination of consent. CANDIDATE NAME: (print full name, including any former names) SSN: A#: DOB: ADDRESS: SIGNATURE: DATE:

6 SANTA FE COMMUNITY COLLEGE TEACHER ACADEMY TESOL ENDORSEMENT PROGRAM TESOL SCHOLARSHIP APPLICATION The TESOL scholarship program is designed to provide financial support to Santa Fe Public School teachers who demonstrate commitment to completing the Santa Fe Community College, TESOL Endorsement Program. The scholarship covers tuition, fees and books. Scholarships are made possible through a U.S. Department of Education Title III grant. There are a limited amount of scholarships available. Criteria include: Full-time employment as a teacher or administrator Completing the endorsement program with a 3.0 GPA or higher No outstanding TESOL materials (magazines, library books, classroom supplies or equipment) Completing of all course, instructor, and program evaluations including an exit interview Recommendation of the instructor Adequate funding Successful obtainment of TESOL endorsement from PED Application Form TO STUDENT: Please complete the following information based on the current school year. All applicants must be licensed teachers (level-one or above) in the Santa Fe Public School District to be eligible. Be sure to verify that the applicant s principal has properly and fully completed the bottom portion of this form. NO APPLICATION WILL BE PROCESSED WITHOUT APPLICANT RESUME ATTACHED. Last Name, First Name, Middle Initial SFCC A# (Student ID Number) Date Employer/School Street Address City, State, Zip Your SFPS Address School Phone (Area Code) Home Street Address City, State, Zip Home Address Home Phone (Area Code) US Citizen or Permanent Resident? Yes No Institution of highest degree earned Cumulativ e GPA Black American/Alaskan Asian/Pacific Islander Highest Degree Earned BA/BS MA/MS PhD Native Hispanic Major Field of Study Male Female Licensure Level Are you fluent in a language other than English? Yes No If yes, what language? How long have you studied this language? Program Interests (Briefly describe your interest in the TESOL Endorsement Program and what you hope to get out of it. Feel free to use the back of this form.) Current Teaching Position: Grade Level: K Content Area Endorsements: APPLICANT S SIGNATURE DATE My signature above indicates that I authorize school officials to release the below information to Santa Fe Community College, Teacher Academy for inclusion in my application for the TESOL Scholarship. SFPS Principal (Current School Administrator): Applicant is employed as a licensed teacher for the current school year. Print name: Title: Date: Telephone: Fax: Note: Contact persons above must be authorized to release student information.

7 Declaration of Major Return your completed form in person to the Enrollment Center, by fax to (505) or by mail to: Enrollment and Student Services, Santa Fe Community College, 6401 Richards Ave., Santa Fe, NM A Student ID Phone Last Name First Name Are you on or applying for Financial Aid? yes no Is this the FIRST time you are declaring a degree? yes no I am declaring a degree changing my degree from: declaring a second degree* * Please indicate which is your first and which is your second degree. Signature Date DEGREES Associate in Arts (AA) and Associate in Science (AS) degrees are for students transferring to other colleges and universities. Transfer of credits is subject to the policy of the institution you are transferring to. Associate in Arts Fashion Design (AD) Accounting (BE) Gallery Management (AD) Photography (AD) Trilingul American Sign Language Interpreting (LC) Architectural Design (AD) Criminal Justice (BE) Early Childhood Education (BE) Fine Arts (AD) Art History Book Arts Ceramics Jewelry Drawing and Painting Printmaking Sculpture Intermedia Associate in Science Biological Sciences (HS) Computer Science (TT) General Engineering (TT) General Studies (LC) Behavioral and Social Sciences Creative Writing Culture and Gender Studies General Studies Humanities Legal Studies (BE) Media Arts (BE) Photography (AD) Psychology (LC) Spanish Language (LC) Teacher Education (BE) General Studies (HS) Physical Sciences (HS) Associate in Applied Arts (AAA) and Associate in Applied Science (AAS) degrees are two-year programs that prepare you for employment. Associate in Applied Arts Professional Crafts (AD) Ceramics Fine Woodworking Jewelry Associate in Applied Science Environmental Accounting Technologies (TT) Solar Energy Entrepreneurship Water Conservation Focus Area Technologies Office Management Exercise Science (HS) Computer and Information Film (BE) select one Technologies (TT) Film Production Criminal Justice (BE) Film Studies Law Enforcement General Studies Specialist (AD, BE, HS, LC, TT) Crime Scene Investigation Interior Design (AD) Culinary Arts (BE) Media Arts (BE) Professional Chef Audio Production Professional Pastry Chef Graphic and Interactive Dental Health (HS) Design Drafting and Engineering Web Technology (TT) Nursing (HS) Early Childhood Paralegal Studies (BE) Education (BE) Respiratory Therapy (HS Continues on back FOR OFFICE USE ONLY Received by: Date: Processed by: Date: SFCC is an equal opportunity/equal access institution. February 2012

8 Declaration of Major continued CERTIFICATES Certificates Academic Transfer Accounting Specialist (BE) American Sign Language Interpreting (LC) Architectural Design (AD) Bilingual Education Endorsement (BE) Biofuels (TT) Computer-Aided Drafting (TT) Creative Writing (LC) Criminal Investigation (BE) Culinary Arts (BE) Dental Assisting (HS) Drafting Technologies (TT) Engineering Technologies (TT) Entrepreneurship (BE) Environmental Technologies (TT) Facility Technologies (TT) Fashion Design (AD) Film Crew (BE) Fine Woodworking (AD) Fitness Instructor Training (HS) Green Building Construction Skills (TT) Green Building Systems (TT) Heating, Ventilation and Air Condition (HVAC) (TT) Hospitality and Tourism (BE) Interior Design (AD) Kitchen and Bath Design (AD) Media Arts (BE) Audio Production Graphic and Interactive Design Web Design Medical Assistant (HS) Nutrition (HS) Office Management (BE) Paralegal Studies (BE) Paramedicine (HS) Patissier (BE) Phlebotomy (HS) Plumbing (TT) Police Supervision (BE) Solar Energy (TT) Substance Abuse Prevention (LC) Teacher Certification (BE) select one Teaching Early Childhood Education Teaching Elementary Education (K-8) Teaching Secondary Education (7-12) Teaching Special Education (K-12) Teaching English to Speakers of Other Languages Traumatic Stress Aide (LC) Water Treatment Operation (TT) AD = School of Arts & Design (505) BE = School of Business, Education & Professional Studies (505) HS = School of Health & Sciences (505) or (505) LC = School of Liberal Arts & Core Studies (505) TT = School of Trades & Technology (505) FOR OFFICE USE ONLY Received by: Date: Processed by: Date:

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