EDUCATIONAL LEADERSHIP CERTIFICATION PROGRAM ONLY APPLICATION FOR ADMISSION. Cohort Information Location for 2014 Start Date Deadline to Apply

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1 EDUCATIONAL LEADERSHIP CERTIFICATION PROGRAM ONLY APPLICATION FOR ADMISSION Admission Requirements Hold a specialist or doctorate degree Be employed in a leadership role as defined by the local system Submit the EDL Certification Only Application Form Submit Letter of Recommendation from local school principal or district Have at least three years of teaching experience Options: A. Hold the EDS or Doctorate in School Leadership B. Hold the EDS or Doctorate in other fields. Cohort Information Location for 2014 Start Date Deadline to Apply Forsyth Campus 300 Aquatic Circle, Cumming, GA Usually Monday or Wednesday evenings 5:30-9:00 May/June 2014 with Prerequisite Requirement August without Pre-requisite Requirement May 19, 2014 June 15, 2014 Important Cohort Notes The Educational Leadership Add-on Certification Program (PL-6) is a Professional Learning Unit (PLU) program that will lead to Performance Leadership -L6- Certification. The total program cost is as follows: Option A: EDL Certification Program-EDS or Doctorate in School Leadership One required course (5 PLU) and a four semester internship(12 PLU) =$2,550 Additionally, a $50.00 non-refundable application fee is required. Cohort payment is due by the first day of class each semester No government financial aid can be requested for this program Option B: EDL Certification Program-EDS or Doctorate in Other Fields Pre-requisite requirement (two courses) plus four required courses and a four semester internship=$6,300 Four required courses and a four semester internship =$4,800 Additionally, a $50.00 non-refundable application fee is required. Cohort payment is due by the first day of class each semester No government financial aid can be requested for this program Upon completion of the EDL Certification Program you will receive PLU Credits from UNG School of Education. Documentation of the completed PLUs will need to be submitted, along with the Professional Standards Commission Certification Application, to the Certification Official at the University of North Georgia. The recommendation form will be completed by the Certification Official and forwarded to the Georgia Professional Standards Commission for certification. During your last semester of the program, you will be given information regarding completing the certification process.

2 Admission Information EDUCATIONAL LEADERSHIP ADD-ON CERTIFICATION PROGRAM APPLICATION 1. Last Name 2. Birth Date 3. Social Security Number 4. First Name 5. Middle Name 6. Other names previously used 7. Permanent Mailing Address 8. City 9. State 10. Zip 11. County 12. Phone Home ( ) Work ( ) 13. Address 14. Sex (optional) Male Female 15. Marital Status (optional) Married Single Divorced Widowed 16. Ethnic Origin (optional) American Indian/Alaskan Native Asian or Pacific Islander White (Non-Hispanic Origin) Black Hispanic Multi-Racial 17. Citizenship Status U.S. Citizen by birth Naturalized U.S. Citizen Non-Resident Alien Visa type (submit copy) Resident Alien (Submit copy of documentation) Country of Citizenship (if not USA) 18. Residency Status Legal Resident of Georgia? Yes Since / Mo. Yr. County of Residence No Please attach explanation. 19. In case of emergency notify: Name/Phone/Relationship 20. Have you ever been suspended or expelled from a college or university for disciplinary reason? No Yes If yes, please attach explanation. 21. Have you ever been convicted of a felony? No Yes If yes, please attach explanation.

3 Educational Information Please list all colleges and universities attended. One official transcript from the institution (except UNG) where a graduate degree was earned must be submitted. Institution City/State Degree/Major Graduation Date Month Year Leadership & Teaching Certification Information Teaching Certificate: Leadership Certificate Number: Level Years Leadership Experience Position: Expiration Date Level Years Teaching Experience (3 Required) Expiration Date I certify that the information provided on this application is true and correct to the best of my knowledge. Signature of Applicant Options: Which program are you applying for?: A. Hold the EDS or Doctorate in School Leadership-- B. Hold the EDS or Doctorate in other fields. APPLICATION CHECKLIST Read and complete your application. Send a copy of your transcript(s) with this application and request an official copy. Official transcripts are required. Enclose your letter of recommendation or have your Principal mail it directly to the address noted below. Enclose the $50.00 non-refundable application fee. Make Checks Payable to: Pioneer RESA Send your completed application packet to: College of Education-EDL Certification Program ATT: Ms. Lori Brooksher/Dr.India Podsen University of North Georgia 82 College Circle Dahlonega, GA 30597

4 EDUCATIONAL LEADERSHIP (PL-6 ) ADD-ON CERTIFICATION PROGRAM ONLY University of North Georgia PLAN OF STUDY Professional Learning Units (17) One Required Course in red and Internship in blue ) 0PTION A: PL-6 ADD-ON CERTIFICATION PROGRAM ONLY WITH ED.S/DOCTORATE IN SCHOOL LEADERSHIP PLAN OF STUDY-(17 PLU)) COURSE NUMBER EDL 7101 COURSE TITLE PLU) Date SCHOOL LEADERSHIP INTERNSHIP-: BUILDING or DISTRICT LEVEL Developing and Designing the Internship EDL 7102 SCHOOL LEADERSHIP INTERNSHIP: BUILDING or DISTRICT LEVEL 3 SPRING EDL 7103 SCHOOL LEADERSHIP INTERNSHIP: BUILDING or DISTRICT LEVEL 3 SU EDL 7008 EDL 7104 *SPECIAL EDUCATION: ORGANIZATIONAL OVERSIGHT AND STAFF DEVELOPMENT- SCHOOL LEADERSHIP INTERNSHIP: BUILDING or DISTRICT LEVEL- Final Folio Due PASS GACE TEST 17 PLU

5 EDUCATIONAL LEADERSHIP (PL-6 ) ADD-ON CERTIFICATION PROGRAM ONLY University of North Georgia Option B PLAN OF STUDY Professional Learning Units ( 32 or 42) Four Required Courses in red with two transfer courses (6 hours in black) and Internship in blue ) Pre-Service Educational Leadership Requirement Prior to enrolling in required coursework, a candidate must meet the Georgia PSC pre-service requirement for performance-based leadership preparation by: holding a clear/renewable Leadership (L) certificate at the master s level or higher, OR holding a master's/specialist degree in Educational/Teacher Leadership, OR completing TCHL 7008 (Ethical and Legal Implications for Leadership) and TCHL7002, (Developing Leadership Capacity in Schools and Communities). Topics addressed in these courses include school law and ethics, organizational leadership, teaching and learning, and using data for school improvement. COURSE NUMBER COURSE TITLE PLU Date TCHL 7002 Pre-Req-Building Leadership Capacity in Schools-ONLINE 5 SU TCHL 7008 Pre-Req- Exploring Professional Roles: Ethical and Legal Implications- ONLINE 5 SU EDL 7002 MANAGING HUMAN RESOURCES: MONITORING TEACHER QUALITY & SCHOOL EFFECTIVENESS EDL 7101 SCHOOL LEADERSHIP INTERNSHIP-: BUILDING or DISTRICT LEVEL Developing and Designing the Internship EDL 7003 MANAGING THE ORGANIZATION: BUSINESS & RESOURCE ADMINISTRATION 5 SPRING EDL 7102 SCHOOL LEADERSHIP INTERNSHIP: BUILDING or DISTRICT LEVEL 3 SPRING EDL 7006 LEADING & EVALUATING CHANGE: SCHOOL & DISTRICT LEVEL INITIATIVES 5 SU EDL 7103 SCHOOL LEADERSHIP INTERNSHIP: BUILDING or DISTRICT LEVEL 3 SU EDL 7008 SPECIAL EDUCATION: ORGANIZATIONAL OVERSIGHT AND STAFF DEVELOPMENT EDL 7104 SCHOOL LEADERSHIP INTERNSHIP: BUILDING or DISTRICT LEVEL- Final Folio Due PASS GACE 32/42 PLU