ENDORSEMENT PROGRAM ADMISSION APPLICATION



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ENDORSEMENT PROGRAM ADMISSION APPLICATION If you are a current or former City University student, please complete Section A of this form and submit it to the Endorsement Specialist. If you are new to City University, please complete Sections A and B. Section A Name: Student ID# Address: Email: I am a current/former student in BA MIT MED Please select the certificate(s) you are applying for: Reading P-12 Special Education P-12 ELL P-12 Middle Level Math 4-9 Middle Level Humanities 4-9 Mathematics 5-12 Review, sign and submit an Endorsement Agreement of Understanding form. Washington Teaching Certificate # Type of Certificate: Certificate Expiration date: Current teaching assignment: Section B Please submit the following application materials to the Office of Admissions: City University Application and non-refundable application fee of $50.00 Copy of valid Washington State Teaching Certificate Unofficial transcripts --------------------------------------------------------------------------------------------------------------------------------------- Please send materials to: City University of Seattle Attention: Endorsements/Sue Seiber 521 Wall Street Seattle WA 98121 (206) 239-4836 FAX (206)239-4849 sseiber@cityu.edu CUF AC 02 1070 09/04

ELL Endorsement Agreement of Understanding For candidates who are seeking the ELL Endorsement, please read, sign, and date below: I recognize that acceptance into the ELL Endorsement program does not guarantee recommendation to OSPI for the endorsement. State of Washington for the endorsement for ELL. offered in the ELL Endorsement with a minimum of 2.0 in each course. I have read and accept the above conditions for entering the ELL Endorsement Program. Please return this document with your application.

Mathematics 5-12 Endorsement Agreement of Understanding For candidates who are seeking the Mathematics Endorsement, please read, sign, and date below: I recognize that acceptance into the Mathematics Endorsement program does not guarantee recommendation to OSPI for the endorsement. State of Washington for the endorsement for Mathematics. offered in the Mathematics Endorsement with a minimum of 2.0 in each course. I have read and accept the above conditions for entering the Mathematics Endorsement Program. Please return this document with your application.

Middle Level Humanities 4-9 Endorsement Agreement of Understanding For candidates who are seeking the Middle Level Humanities Endorsement, please read, sign, and date below: I recognize that acceptance into the Middle Level Humanities Endorsement program does not guarantee recommendation to OSPI for the endorsement. State of Washington for the endorsement for Middle Level Humanities. offered in the Middle Level Humanities Endorsement with a minimum of 2.0 in each course. I have read and accept the above conditions for entering the Middle Level Humanities Endorsement Program. Please return this document with your application.

Middle Level Mathematics 4-9 Endorsement Agreement of Understanding For candidates who are seeking the Middle Level Mathematics Endorsement, please read, sign, and date below: I recognize that acceptance into the Middle Level Mathematics Endorsement program does not guarantee recommendation to OSPI for the endorsement. State of Washington for the endorsement for Middle Level Mathematics. offered in the Middle Level Mathematics Endorsement with a minimum of 2.0 in each course. I have read and accept the above conditions for entering the Middle Level Mathematics Endorsement Program. Please return this document with your application.

Reading P-12 Endorsement Agreement of Understanding For candidates who are seeking a Reading Endorsement, please read, sign, and date below: I recognize that acceptance into the Reading Endorsement program does not guarantee recommendation to OSPI for the endorsement. experience(s), and pass the WEST E exam to be recommended to the State of Washington for the endorsement. I must successfully complete all required courses with a minimum of 2.0 in each course and a four credit internship following successful completion of the WEST E exam. I have read and accept the above conditions for the Reading Endorsement Program. Please return this document with your application.

Special Education Agreement of Understanding For candidates who are seeking a Special Education Endorsement Only, please read, sign, and date below: I recognize that acceptance into the Special Education Endorsement Only program does not guarantee recommendation to OSPI for the endorsement. I acknowledge that I must pass the WEST E exam requirement to be recommended to the State of Washington for the endorsement for Special Education. to engage in a student teaching internship. offered in the Special Education Endorsement Only with a minimum of 2.0 in each course. I have read and accept the above conditions for entering the Special Education Endorsement Program. Please return this document with your application.