EDUCATIONAL LEADERSHIP CERTIFICATION PROGRAM ONLY APPLICATION FOR ADMISSION (Pending Final Approval by the Georgia Professional Standards Commission)

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1 EDUCATIONAL LEADERSHIP CERTIFICATION PROGRAM ONLY APPLICATION FOR ADMISSION (Pending Final Approval by the Georgia Professional Standards Commission) Admission Requirements Hold a specialist or doctorate degree in Educational Leadership (OPTION A) OR in a teaching or service field (OPTION B) 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 Cohort Information Location for 2013 Start Date Deadline to Apply Cumming Campus 300 Aquatic Circle, Cumming, GA Usually Monday or Wednesday evenings 5:30-9:00 May/June 2014 for candidates needing the prerequisite courses August 2014 for candidates not needing pre-requisite courses April 15, 2014 June 15, 2014 Important Cohort Notes The Educational Leadership Add-on Certification Program (PL) is a Professional Learning Unit (PLU) program that will lead to Performance Leadership Certification. The EDL Certification Program requires Six Courses-Two transfer courses from your EDS Program, Four Courses, and the Internships The total program cost is as follows: For OPTION A Candidates: One required course and a four semester internship = $2,550 For OPTION B Candidates: Pre-requisite requirement (two courses) plus four required courses and a four semester internship=$6,300 OR o 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 the University of North Georgia College 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 College if Education. 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 detailed 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) 19. In case of emergency notify: 18. Residency Status Legal Resident of Georgia? Yes Since / Mo. Yr. County of Residence No Please attach explanation. 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 NGCSU) 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 ) Expiration Date I certify that the information provided on this application is true and correct to the best of my knowledge. I am applying for: OPTION A Program OPTION B Program Signature of Applicant 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 (Performance Based) ADD-ON CERTIFICATION PROGRAM ONLY PLAN OF STUDY Professional Learning Units Pre-Service Educational Leadership Requirement Prior to enrolling in required coursework, a candidate must meet the Georgia Professional Standards Commission 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 holding a specialist or doctorate degree in teaching or service fields from an accredited college or university AND 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. PLAN OF STUDY OPTION B CANDIDATES The EDL Certification Program requires Six Courses-Two transfer courses from your EDS Program, Four Courses, and the Internships (OPTION A LISTED AFTER THIS PLAN OF STUDY) COURSE NUMBER COURSE TITLE PLUs Date Pre-requisite Courses TCHL 7002 Building Leadership Capacity in Schools-ONLINE 5 SU 1 TCHL 7008 Exploring Professional Roles: Ethical and Legal Implications- ONLINE 5 SU 1 * courses -If the candidate has expertise in this area, then another course from the EDL program can be substituted that best fits the needs of the candidate. These courses are indicated by *** Two transfer courses that match any of the EDL courses. These courses are indicated by *** All Internships are required. EDL 7001*** EDL 7002* EDL 7101 SCHOOL & COMMUNITY: COLLABORATING & NETWORKING FOR SCHOOL IMPROVEMENT MANAGING HUMAN RESOURCES: MONITORING TEACHER QUALITY & SCHOOL EFFECTIVENESS SCHOOL LEADERSHIP INTERNSHIP-: BUILDING or DISTRICT LEVEL Developing and Designing the Internship FALL 1 5 FALL 1 3 FALL 1

5 COURSE NUMBER COURSE TITLE PLUs Date EDL 7003* EDL 7004*** EDL 7102 MANAGING THE ORGANIZATION: BUSINESS & RESOURCE ADMINISTRATION PROMOTING STUDENT ACHIEVEMENT THROUGH DATA DRIVEN DECISION-MAKING LEVEL 5 SPRING 1 SPRING 1 3 SPRING 1 EDL 7005*** EDL 7006* EDL 7103 SIZING UP EXTERNAL SCHOOL ENVIRONEMENTS: POLITICAL, SOCIAL & LEGAL CONTEXTS LEADING & EVALUATING CHANGE: SCHOOL & DISTRICT LEVEL INITIATIVES LEVEL SU 2 5 SU 2 3 SU 2 EDL 7007*** EDL 7008* EDL 7104 BUILDING PROFESSIONAL LEARNING COMMUNITIES: ASSESSING TEACHER RETENTION/WORK CONDITIONS SPECIAL EDUCATION: ORGANIZATIONAL OVERSIGHT AND STAFF DEVELOPMENT LEVEL- Final Folio Due Program Exit GACE Test in Leadership FALL 2 5 FALL 2 3 FALL 2 32/42 PLUs OPTION A Candidates must complete all 12 PLUs of the Internships and EDL 7008 (or an approved substitution based on candidate expertise). Total program is 17 PLUs.