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1 Dear Prospective Student: Thank you for your interest in our School Counseling (K-8 and 7-12) certification programs at Missouri State University. By completing the following application materials, you will be admitted to Missouri State University as a post-masters, non-degree seeking student, and we will establish a certification file for you in the. This will allow our office to track your progress toward certification once fully admitted to the counseling program. Once we receive all of your application materials and an official transcript from every College or University you have attended, we will complete an Individualized Program of Study (IPS) for you. This document will describe all coursework you will be required to complete for certification as a school counselor or Psychological Examiner, and will be used by both you and your assigned advisor when discussing registration for courses. You will be advised by a faculty member in the Counseling Department. Once admitted, you will be assigned an advisor by that department. However, questions specifically about certification may be directed to me by calling the at or by ing me at: Best of luck as you pursue this academic program! Sincerely, Scott Fiedler Director of Student Services Certification Officer

2 CERTIFICATION CHECKLIST In order to be recommended for certification at the end of your academic program, all of the following must be submitted to the Teacher Certification Office: Program Declaration Form Transcript Analysis Request Form Transcript Analysis Fee ($50.00) Transcripts from every institution (college or university) you have ever attended, (except Missouri State and MSU West Plains) even if those courses have been transferred to another institution or appear on your Missouri State transcript.

3 Instructions to Complete this Packet Program Declaration Form: Use this form to indicate which area or areas of certification you wish to pursue. This will determine which Individualized Program of Study we complete for you, and which area of certification we will recommend you for when you finish your program. If you decide later to add an additional area of certification, or if you decide not to pursue an added area that you put on this form, just call our office and ask us to make that change to your record. Transcript Analysis Request Form: Please complete this entire form. This information is needed for us to enter you into our Teacher Certification Database, to admit you to Missouri State University, and to track your progress toward certification. Transcript Analysis Fee: This fee is required of every student who establishes a file in the. The Transcript Analysis Fee for all students pursuing Counseling certification is currently $ This can be paid by cash, check, money order or you can call and pay over the phone with a credit card. You do not have to pay additional fees for adding other areas of counseling certification. Transcripts: In order to recommend you for certification in Missouri, we need an official transcript from every college or university you have ever attended regardless of whether those courses were transferred to another institution, were required for certification, or were required for your program. These transcripts will be sent to the Department of Elementary and Secondary Education (DESE) when we recommend you for certification. Please use the enclosed form to request your transcripts. This form should be sent to each institution you have attended. They will then send the transcript directly to our office. We will request your Missouri State transcript.

4 Questions? Please call and ask to speak with: Scott Fiedler Director of Student Services Certification Officer Please return all materials to the in the enclosed return envelope, or you can mail it to our office at:

5 TEACHER CERTIFICATION OFFICE PROGRAM DECLARATION FORM For Students with a Related Master s Degree NAME SS# My Master s Degree is in: I earned my Master s Degree at: Year completed: I INTEND TO PURSUE THE FOLLOWING CERTIFICATION AS MY PRIMARY PROGRAM AT MISSOURI STATE (Please check only one): SCHOOL COUNSELING (K-8) SCHOOL COUNSELING (7-12) SCHOOL PSYCHOLOGICAL EXAMINER (K-12) I ALSO INTEND TO ADD THE FOLLOWING CERTIFICATION(S) TO MY PRIMARY PROGRAM: (please check all that apply) SCHOOL COUNSELING (K-8) SCHOOL COUNSELING (7-12) SCHOOL PSYCHOLOGICAL EXAMINER (K-12) STUDENT SIGNATURE DATE

6 Application for Post-Baccalaureate Admissions and Teacher Certification Transcript Analysis APPLICANT INFORMATION (please print) Last Name: Mailing Address: This form is both your application to Missouri State University as a Post-Bac, teacher certification student and your request for an Official Transcript Analysis from the. If you are applying to a graduate program, you must also complete that application process separately. First Name: M.I.: All Maiden or Former Names: County: City: State: Zip: Work Phone: Address: Home Phone: Cell Phone: *SSN: Date of Birth: / / *Disclosure of your social security number (SSN) is required. If you provide your SSN, it will be used for various administrative purposes at the University. It is required for certification with the Department of Elementary and Secondary Education. Have you ever been convicted of or pled guilty to a crime other than a traffic offense or are any criminal charges pending against you, or have you been dismissed/suspended from another college or university for disciplinary reasons? YES NO (If yes explain on separate sheet.) Do you currently hold a teaching certificate in any area? YES NO If yes, what state? If you are currently certified, please provide a copy of your teaching certificate with this application. Are you a citizen of the United States? YES NO Is your legal residence in Missouri? YES NO Ethnic Status (optional/for statistical reporting only) African American European American Asian American Mexican American/Latin Native American American/Hispanic Other If yes, how long? More than a year Less than a year If not a Missouri resident, of what state and county are you a resident? COLLEGE OR UNIVERSITY ENROLLMENT HISTORY (please print) List ALL accredited colleges and universities from which you have earned credit (including Missouri State), even if credits were transferred to another institution. All original, official transcripts are required by the to complete the transcript analysis (official transcripts are in a sealed envelope from the college or university when received in the ). Received College Name City/State Degree(s) Awarded SIGNATURE I certify that the information I have provided is accurate and acknowledge that falsified information may result in suspension from Missouri State University with loss of fees. I also agree that I am subject to the University s policies, rules and requirements applicable to students including, but not limited to, those stated in the University catalogs, class schedules, computer use policies and the Student Code of Rights and Responsibilities. Student s Signature Date / / FOR OFFICE USE ONLY Analysis Fee: $ Date Received / / Processed by: Date: / / M DB Admit Notes: Credit Card: Visa Master Card Cash Check #

7 Provided below are forms to use to request your official academic transcript(s) to be mailed directly from your previous college(s) to Missouri State University's. Transcript Request Form For students seeking Post-Baccalaureate Teacher Certification at Missouri State University Name Last First M.I. Address Street City State Zip Social Security Number To: Records Office College or University Last Term and Year Attended Fall Spring Summer Year Number of copies to be sent 1 Birthdate Month/Date/Year Phone Number ( ) All other names under which you may have enrolled: Signature Please send my official transcript to: Missouri State University Check one of the following: Mail immediately Mail after current term grades are posted Mail after degree is posted Please complete this form and mail it to the records office of the previous institution(s) attended. Many schools require fee payment with transcript requests. Transcripts must be sent directly from the previous institution(s) to Missouri State to be considered official. Your transcript analysis will not be processed until all official transcripts arrive. Transcript Request Form For students seeking Post-Baccalaureate Teacher Certification at Missouri State University Name Last First M.I. Address Street City State Zip Social Security Number To: Records Office College or University Last Term and Year Attended Fall Spring Summer Year Number of copies to be sent 1 Birthdate Month/Date/Year Phone Number ( ) All other names under which you may have enrolled: Signature Please send my official transcript to: Missouri State University Check one of the following: Mail immediately Mail after current term grades are posted Mail after degree is posted Please complete this form and mail it to the records office of the previous institution(s) attended. Many schools require fee payment with transcript requests. Transcripts must be sent directly from the previous institution(s) to Missouri State to be considered official. Your transcript analysis will not be processed until all official transcripts arrive. Transcript Request Form For students seeking Post-Baccalaureate Teacher Certification at Missouri State University Name Last First M.I. Address Street City State Zip Social Security Number To: Records Office College or University Last Term and Year Attended Fall Spring Summer Year Number of copies to be sent 1 Birthdate Month/Date/Year Phone Number ( ) All other names under which you may have enrolled: Signature Please send my official transcript to: Missouri State University Check one of the following: Mail immediately Mail after current term grades are posted Mail after degree is posted Please complete this form and mail it to the records office of the previous institution(s) attended. Many schools require fee payment with transcript requests. Transcripts must be sent directly from the previous institution(s) to Missouri State to be considered official. Your transcript analysis will not be processed until all official transcripts arrive.

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