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Application for
Admission to the NCSU ESL Licensure Program
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Last name: |
________________________ |
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First name: |
________________________ |
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Middle name: |
________________________ |
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Maiden name: |
________________________ |
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Mailing
Address: |
_____________________________________________________________
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_____________ |
________________ |
_________ |
_______________
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City |
County |
State |
Postal Code |
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Home Phone: |
( ) ______ -
________ |
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Business
Phone: |
( ) ______ -
________ |
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Fax: |
( ) ______ -
________ |
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Employer:
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_____________________________________________________________________ |
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Email Address/es:
(required)
Your application will not be considered w/o it. |
_____________________________________________________________________ |
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Date of Birth: |
_____ / _____ /
_____ |
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Month / Day /
Year |
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Sex: |
M or F |
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NC resident: |
YES NO
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Country of
Citizenship: |
______________________________ |
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(and visa status
if not a U.S. citizen) |
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Non-native speaker of English |
NO
YES (see language proficiency requirements under
attachments section) |
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I am applying for _________ (semester) _________ (year) |
Applicant Ethnic
Group:
Ethnic identification is required by the Office of Civil Rights of the
Department of Education to assure compliance with the Civil Rights Act.
Ethnic origin is not a factor in admission. All applicants are
considered without reference to sex, creed, or race.
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Asian or Pacific Islander |
Native American |
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African-American |
White (not Hispanic) |
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Hispanic |
Other |
Highest Degree
Earned
__________________________________________________________
1. Current / Last
College Attended
_________________________________________________
(Dates of
Attendance) From _____ / _____ Until _____ / _____
Degree received:
YES NO
2. Previous College
Attended
____________________________________________________
(Dates of
Attendance) From _____ / _____ Until _____ / _____
Degree received:
YES NO
3. Previous College
Attended
_____________________________________________________
(Dates of
Attendance) From _____ / _____ Until _____ / _____
Degree received:
YES NO
Signature required below.
I hereby affirm
that all of the information on this application form is correct.
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__________________________________________ |
________________________ |
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Signature |
Date |
Attachments
Attach the following documents to your application. Only complete
application packets will be considered.
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Photocopy of current
initial or continuing North Carolina Teaching License.
Applicants with a provisional or temporary/emergency status in the
primary area will not be considered.
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Transcripts from
all accredited 4-year colleges or universities attended including proof of at least 2
semesters of foreign language.
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A personal statement
(1/2 - 1 page) of your professional goals
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2 professional letters of
recommendation from a supervisor or administrator (supervising
administrator, lead teacher, counselor etc.)
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Description of your
foreign language background (1/2 - 1 page), including courses, living
abroad, home language, etc.
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Notification of Test
of English as a Foreign Language Score of 250 (Computer-Based TOEFL)
or 600 (Paper-Based TOEFL). This requirement is for nonnative speakers
of English only.
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Notification of Test
of Spoken English (TSE) or SPEAK Test score of 50. This requirement is
for nonnative speakers of English only. NC State administers the
SPEAK. If you wish to take the test at NC State, contact the ESL
Licensure Coordinator for details about time and cost at
919-515-9299.As an alternative, you may take the Test of Spoken
English. This test is administered at approved testing centers. Go to
www.ets.org for more information.
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$50 non-refundable
application fee made out to Dept. of Foreign Languages and
Literatures.
APPLICATION
DEADLINE:
November 1 for spring semester
May 1 for fall semester
Send completed
application to:
Coordinator, ESL Licensure
NCSU, Box 8106
Raleigh, NC 27695-8106
Further
information:
(919) 515-9299
(919) 513-7034 (fax) |
