宅男研究所

Admission to Teacher Education Application

To start, go to the 宅男研究所 Educator Preparation webpage (www.eiu.edu/edprep), where you will select links to discover the information you need to complete the questions below.

Most fields are required and must be accurate, so be sure to check your work.

Be sure to use your name as registered at 宅男研究所 (no nicknames).

Once you have completed the form, be sure to submit it.

Information About You

Please complete all of this information accurately and as registered at 宅男研究所.
Name (as Registered at 宅男研究所; No Nicknames) Name (as Registered at 宅男研究所; No Nicknames) First Last
Preferred Name (Skip if your preferred name is the same as the name listed in question 1.
Preferred Pronouns
E-Number
IEIN Number
宅男研究所 Email (Must Use 宅男研究所 Email Address)
I am a teacher education candidate who is completing a licensure program

I am a teacher education candidate who is completing a licensure program on campus (select if you are an undergraduate) in an off campus cohort in an online cohort through the MAT
Class standing

Class standing Freshman Sophomore Junior Senior Post-Baccalaureate
Education Major (if Dual Major, Select Primary Area)

Education Major (if Dual Major, Select Primary Area) Early Childhood Education (Birth-Grade 2) Elementary Education (Grades 1-6) Middle Level Education (Grades 5-8) Early Childhood Special Education Special Education - Standard English Language Arts (Grades 9-12) History-Social Science (Grades 9-12) Mathematics (Grades 9-12) Science (Biology) (Grades 9-12) Science (Chemistry) (Grades 9-12) Science (Earth Science) (Grades 9-12) Science (Physics) (Grades 9-12) Physical Education (Grades K-12) Art Education (Grades K-12) Music Education (Grades K-12) Foreign Language - Spanish (Grades K-12) Foreign Language - French (Grades K-12) Foreign Language - German (Grades K-12) CTE - Family and Consumer Science (Grades 6-12) CTE - Business (Grades 6-12) CTE - Technology (Grades 6-12) Unsure
Advisor
I understand that in order to be considered for a field placement within a school I must consent to a Criminal Background Investigation.

I understand that in order to be considered for a field placement within a school I must consent to a Criminal Background Investigation. Yes No
I understand that the investigation may require that I submit identifying information to 宅男研究所's approved background check vendor.

I understand that the investigation may require that I submit identifying information to 宅男研究所's approved background check vendor. Yes No
I understand that I am responsible for all charges and forms associated with this investigation.

I understand that I am responsible for all charges and forms associated with this investigation. Yes No
Have you, in Illinois or any other state, been convicted of a felony or any sex, narcotics, or drug offense?

Have you, in Illinois or any other state, been convicted of a felony or any sex, narcotics, or drug offense? Yes No
Have you been found guilty of child abuse or neglect or had a DCFS indication of child abuse or neglect?

Have you been found guilty of child abuse or neglect or had a DCFS indication of child abuse or neglect? Yes No
I certify that the information appearing in this document is correct.

I certify that the information appearing in this document is correct. Yes No
Furthermore, I understand and agree to abide by the requirements for University Admission to Teacher Education as presented in the Admission to Teacher Education Meeting.

Furthermore, I understand and agree to abide by the requirements for University Admission to Teacher Education as presented in the Admission to Teacher Education Meeting. Yes No
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

宅男研究所

Admission to Teacher Education Application

Admission to Teacher Education Application

Information About You