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Fall Application Due by March 30 th Secondary Education Application Teacher Candidate Applicant Information Full Name: Address: Last First Middle Name Street Address Apartment/Unit # City State ZIP Code Home Phone: ( ) Cell Phone (optional): ( ) Student ID #: 9000 Email address: @daltonstate.edu For which secondary content area are you applying? Biology Chemistry English History Math * GA CERT ID # (From MyGaPSC GACE Registration) * If exempt from the GACE Program Admission Exam, students are still required to set up their MyGaPSC account before application deadline date. Signature of Applicant Date SOE Representative Date DEAN SIGNATURE Date 1 P age Revised 02/06/ 2014

APPLICATION REQUIREMENTS - STUDENT CHECK OFF LIST **ADMISSION TO DALTON STATE COLLEGE IS REQUIRED BEFORE ACCEPTANCE INTO THE TEACHER EDUCATION PROGRAM** 1. Completed 30 core academic hours 2. Obtained a School of Education Program GPA of 2.7 or above, cumulative, in academic work 3. Completed all Area A courses with a grade of C or above 4. Completed all EDUC 2110, EDUC 2120, and EDUC 2130 with a grade of C or above 5. Completed COMM 1110: Oral Communications with a grade of C or above 6. Completed PSYC 1101: Intro to Psychology with a grade of C or above 7. Completed these courses in your content area with grades of C or above: BIOLOGY BIOL 1107K and BIOL 1108K; OR CHEMISTRY CHEM 1211 and 1212; OR ENGLISH ENGL 3010 plus 3 credit hours of a 3000 level ENGL; OR HISTORY HIST 3950 plus 3 credit hours of a 3000 level HIST; OR MATH - 8 credit hours of content curriculum courses (MATH 2253, 2254, 2255, etc.) 8. Passed all three GACE Program Admissions Exams, or evidence of exemption* (See exemption status below.) 9. Criminal Background Check Report is up-to-date. 10. Teacher Liability Insurance is up-to-date. 11. Read and signed the DSC/GaPSC Honesty Policy 12. Two letters of reference from professional sources (reference forms attached) * One recommendation MUST be from your EDUC 2110 Instructor 13. Completion of the Mandated Reporters: Critical Links and Protecting Children of Georgia online training 14. Passed the Georgia PSC Code of Ethics Assessment. 15. Attended the Secondary Orientation 16. Signed the Schedule of Courses 17. Reviewed this check off sheet 18. Completed and submitted Application for Admission to Secondary Teacher Education by the posted due date **Exemption from GACE Program Admissions Exams: SAT = minimum combined verbal and math score of 1000; or ACT = minimum combined English and math score of 43; or GRE = if tested prior to August 1, 2011, a minimum combined verbal and quantitative score of 1030. If tested after August 1, 2011, a minimum combined verbal and quantitative score of 297. All accepted exemption examination scores must be completed and reported no later than 5 years before the teacher education application deadline. Any scores reported later than 5 years will not be accepted for exemption. RETENTION POLICY In addition to the specific requirements for admission to teacher education, the candidate must meet the following requirements for retention in teacher education programs: 1. Maintain a minimum 2.7 GPA each semester 2. Earn a grade of C or better in all professional education block courses, field experience courses, and supporting professional education courses 3. Complete successfully all field experience requirements 4. Achieve appropriate scores on teacher candidate APBD and TCOI assessments each semester 5. Present knowledge, skills, and attitudes appropriate in the various stages of the preparation program, including the demonstration of responsible and professional behaviors and interactions with peers, faculty, and children. 2 P age Revised 02/06/2014

SCHEDULE OF EDUCATION COURSES PES I Courses 5 credit hours EDUC 3902 : Curriculum & Assessment for Secondary Students EDUC 3272 : Classroom Management Seminar I for Secondary Students * 15 hours per week in field experience; LiveText Purchase PES II Courses 5 credit hours EDUC 4901: Methods & Strategies for Secondary Teachers EDUC 3273: Classroom Management Seminar II for Secondary Students * 15 hours per week in field experience PES III Courses 5 credit hours EDUC 4951: Teaching Diverse Learners EDUC 3274: Classroom Management Seminar III for Secondary Students * 15 hours per week in field experience PES IV Courses- Internship 12 credit hours EDUC 4953: Internship for Secondary Students EDUC 3120: Internship Seminar for Secondary Students READ 3456: Reading & Writing Across the Curriculum *15 weeks in field experience *As indicated by my signature below, I have read and understand the Secondary Education schedule of courses. Signature: Date: 3 P age Revised 02/06/2014

Georgia Professional Standards Commission Georgia Code of Ethics Effective October 15, 2009 505-6-.01 THE CODE OF ETHICS FOR EDUCATORS (1) Introduction. The Code of Ethics for Educators defines the professional behavior of educators in Georgia and serves as a guide to ethical conduct. The Professional Standards Commission has adopted standards that represent the conduct generally accepted by the education profession. The code defines unethical conduct justifying disciplinary sanction and provides guidance for protecting the health, safety and general welfare of students and educators, and assuring the citizens of Georgia a degree of accountability within the education profession. (d) Standard 4: Honesty - An educator shall exemplify honesty and integrity in the course of professional practice. Unethical conduct includes but is not limited to, falsifying, misrepresenting or omitting: 1. professional qualifications, criminal history, college or staff development credit and/or degrees, academic award, and employment history; 2. information submitted to federal, state, local school districts and other governmental agencies; 3. information regarding the evaluation of students and/or personnel; 4. reasons for absences or leaves; 5. information submitted in the course of an official inquiry/investigation; and 6. information submitted in the course of professional practice. My signature verifies that: a) I have read the Georgia Code of Ethics honesty policy above and I understand that as a Teacher Candidate enrolled in the School of Education program at Dalton State College, I must be honest when reporting field placement hours that I have completed during a given semester; b) I understand that if it is determined that I have falsified hours or forged signatures, I will fail field experience for the given semester, and may be subject to being dismissed from the School of Education program. In order to be readmitted to the program, I will have to file an appeal and will be subject to repeating all the required field experience hours and the seminar class for the given semester in which documentation was falsified; c) I understand that if I have questions regarding the honesty policy or possible consequences of falsifying placement hours and/or signature(s) documentation, it is my responsibility to conference with the Director of Field Experiences or the Dean of the School of Education to reach full understanding of the policy, and d) I understand that field experience hours and signatures I submit are subject to verification by the Director of Field Experiences. Print Name Legal Name TCs Signature Date 4 P age Revised 02/06/2014

RECOMMENDATION FOR TEACHER EDUCATION ADMITTANCE Optional Statement: I hereby authorize Dalton State College to use confidential information, including but not limited to letters, statements, and recommendations received in connection with my request for admission, to determine admission to the School of Education, and I hereby waive my right of access to these materials. Signature Date The applicant has indicated above whether access to this recommendation has been waived. We appreciate your cooperation. Please mail to: School of Education, Dalton State College, 650 College Drive, Dalton, GA 30720 EVALUATION AREA BELOW ABOVE (UPPER 25%) SUPERIOR (TOP 10%) Written Expression Oral communication skills Character/Integrity Disciplined work habits Attitude Intellectual ability Initiative and Motivation Recommendation to become a classroom teacher of elementary children Strongly Recommend Recommend Recommend with reservation (please call me) Do not recommend Please add any additional comments that might assist us in making a judgment about the applicant s admission to Teacher Education. Printed Name Relationship to Candidate Position Address Signature Date 5 P age Revised 02/06/2014

RECOMMENDATION FOR TEACHER EDUCATION ADMITTANCE Optional Statement: I hereby authorize Dalton State College to use confidential information, including but not limited to letters, statements, and recommendations received in connection with my request for admission, to determine admission to the School of Education, and I hereby waive my right of access to these materials. Signature Date The applicant has indicated above whether access to this recommendation has been waived. We appreciate your cooperation. Please mail to: School of Education, Dalton State College, 650 College Drive, Dalton, GA 30720 EVALUATION AREA BELOW ABOVE (UPPER 25%) SUPERIOR (TOP 10%) Written Expression Oral communication skills Character/Integrity Disciplined work habits Attitude Intellectual ability Initiative and Motivation Recommendation to become a classroom teacher of elementary children Strongly Recommend Recommend Recommend with reservation (please call me) Do not recommend Please add any additional comments that might assist us in making a judgment about the applicant s admission to Teacher Education. Printed Name Relationship to Candidate Position Address Signature Date 6 P age Revised 02/06/2014