Documenti di Didattica
Documenti di Professioni
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APPLICATION
SINGLE SUBJECT / MULTIPLE SUBJECT / EDUCATION SPECIALIST / ECO
PLEASE PRINT IN BLACK INK OR TYPE ALL INFORMATION REQUIRED. INCLUDE OFFICIAL TRANSCRIPTS, COPIES OF CBEST, US CONSTITUTION
REQUIREMENT, SUBJECT MATTER TEST SCORES (OR WAIVER), RESUME, ESSAY, THREE PROFESSIONAL RECOMMENDATIONS ON REQUIRED FORM,
CERTIFICATE OF CLEARANCE, AND A NON-REFUNDABLE APPLICATION FEE WITH YOUR APPLICATION. (ALTHOUGH THE INFORMATION BELOW MAY BE
ON YOUR RESUME, IT MUST ALSO BE COMPLETED ON THE APPLICATION.) ALL MATERIALS MUST BE RECEIVED IN THE
SACRAMENTO OFFICE NO LATER THAN THE POSTED DEADLINE: MARCH 5 FOR EARLY BIRD DEADLINE ($60
APPLICATION FEE), APRIL 1 FOR THE REGULAR DEADLINE ($75 APPLICATION FEE), OR APRIL 30 FOR THE LATE
DEADLINE ($100 APPLICATION FEE).
PROGRAM CHOICE: PLEASE CHECK THE BOX OF THE PROGRAM TO WHICH YOU ARE APPLYING:
SINGLE SUBJECT
MULTIPLE SUBJECT
EDUCATION SPECIALIST
ECO
PERSONAL INFORMATION:
MR.
MS.
MRS. ______________________________
LAST NAME
______________________ __________
FIRST NAME
MI
_______________________.________
EMAIL ADDRESS
_____________________________ @
______________________________________________
STREET
______________________________________________
STREET
YES
NO
HAVE YOU EVER BEEN CONVICTED OF, OR ENTERED A PLEA OF NO CONTEST TO ANY FELONY OR MISDEMEANOR OTHER THAN A TRAFFIC
VIOLATION?
YES
NO
IF YES, PLEASE ATTACH AN EXPLANATION IN A SEALED ENVELOPE.
PLEASE CHECK THE BOX THAT APPLIES TO YOU (OPTIONAL):
AFRICAN-AMERICAN
AMERICAN INDIAN/ALASKAN NATIVE
ASIAN
LATINO
WHITE
PACIFIC ISLANDER
OTHER: SPECIFY _______________________________
TESTING REQUIREMENTS:
HAVE YOU TAKEN AND PASSED THE CALIFORNIA BASIC EDUCATION SKILLS TEST (CBEST)?
YES
DATE PASSED: _______________
NO
I AM AWAITING SCORES FROM TEST TAKEN ON (DATE) _______________ AND WILL PERSONALLY FORWARD THE SCORES
TO FORTUNE SCHOOL OF EDUCATION. (NOTE: SCORES ARE NOT FORWARDED BY TESTING AGENCY WHEN REQUESTED)
HAVE YOU TAKEN AND PASSED THE CALIFORNIA SUBJECT EXAMINATION TESTS FOR TEACHERS (CSETS)?
YES
DATE PASSED: _______________
NO
I AM AWAITING SCORES FROM TEST TAKEN ON (DATE) _______________ AND WILL PERSONALLY FORWARD THE SCORES
TO FORTUNE SCHOOL OF EDUCATION. (NOTE: SCORES ARE NOT FORWARDED BY TESTING AGENCY WHEN REQUESTED)
DO YOU HAVE A SUBJECT MATTER COMPETENCY WAIVER LETTER FROM AN APPROVED CALIFORNIA UNIVERSITY?
YES
NO
IF YES, FROM WHICH UNIVERSITY DID YOU RECEIVE YOUR WAIVER LETTER? ________________________ DATE: _______________
ATTENDED
FROM
TO
MAJOR
POSITION(S)
GRADE OR SUBJECT
AREA TAUGHT
DATE
FROM
TO
POSITION(S)
GRADE OR SUBJECT
AREA TAUGHT
DATE
FROM
TO
PROFESSIONAL RECOMMENDATIONS:
THREE PROFESSIONAL REFERENCES MUST BE INCLUDED WITH YOUR APPLICATION PACKAGE. FOR THESE RECOMMENDATIONS, YOU ARE
REQUIRED TO USE THE FORTUNE SCHOOL OF EDUCATION RECOMMENDATION FORM. THESE FORMS CAN BE FOUND ONLINE AT
HTTP://WWW.FORTUNESCHOOL.US/GRADUATE-SCHOOL/ADMISSIONS-DISTRICT-INTERN-PROGRAM.
NO
I HAVE A CONTRACTED FULL-TIME TEACHING POSITION SECURED WITH A FORTUNE SCHOOL OF EDUCATION DISTRICT PARTNER
FOR THE 2015-2016 SCHOOL YEAR.
DISTRICT: ______________________ SCHOOL SITE: ______________________ SUBJECT: ____________________
PLEASE INCLUDE A COPY OF YOUR CONTRACT OR OFFER LETTER WITH YOUR APPLICATION PACKAGE.
I DO NOT HAVE A CONTRACTED FULL-TIME TEACHING POSITION SECURED WITH A FORTUNE SCHOOL OF EDUCATION
DISTRICT PARTNER FOR THE 2015-2016 SCHOOL YEAR.
PLEASE MARK BELOW THE COUNTY IN WHICH YOU WOULD LIKE TO TEACH AND TAKE FORTUNE SCHOOL OF EDUCATION COURSES:
SACRAMENTO (SACRAMENTO COUNTY/CAPITOL CITY/CENTRAL VALLEY)
BAY AREA
(CONTRA COSTA COUNTY/ALAMEDA COUNTY)
NO PREFERENCE
PLEASE SELECT THE SUBJECT MATTER YOU WOULD LIKE TO TEACH DURING THE 2015-2016 YEAR:
MULTIPLE SUBJECT
SINGLE SUBJECT
SPECIAL EDUCATION
____________________________________________
YES
SPECIAL SKILLS/TRAINING:
NO
BCLAD CERTIFICATE
CLAD CERTIFICATE
EMERGENCY PERMIT
SS/MS/ES CALIFORNIA TEACHING CREDENTIAL
LANGUAGES ABILITIES OTHER THAN ENGLISH:
LANGUAGE ABILITIES
LANGUAGE 1 (SPECIFY):
YES
LANGUAGE 2 (SPECIFY):
NO
YES
NO
SPEAK FLUENTLY
WRITE FLUENTLY
CERTIFICATION OF APPLICATION:
I HEREBY CERTIFY THAT ALL INFORMATION IN THIS APPLICATION AND IN SUPPORT OF THIS APPLICATION IS TRUE AND COMPLETED TO THE BEST OF MY
KNOWLEDGE. FALSIFICATION OF ANY INFORMATION ON THIS APPLICATION MAY BE GROUNDS FOR DISQUALIFICATION OR DENIAL OF ADMISSION OR, IF
DISCOVERED AFTER ADMISSION, GROUNDS FOR DISMISSAL FROM FORTUNE SCHOOL OF EDUCATION. I UNDERSTAND THAT I MUST NOTIFY THE
ADMISSIONS DEPARTMENT IF RESPONSES TO THE INFORMATION REQUESTED ON THIS APPLICATION CHANGE PRIOR TO ENROLLMENT.
______________________________________________
_______________________
SIGNATURE OF APPLICANT
DATE