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The Policy Studies Department requires that the applicant for the secondary program (7-12) to document a minimum of 45 hours of direct experience with adolescent students and for the elementary program (kindergarten through 8), a minimum of 60 hours of experience with children in an instructional or classroom setting within the past five years.
Educational objective:
Single Subject BCLAD__________ Multiple Subject BCLAD________________
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Name of applicant (please print) Social Security
# Date
The person named above has had ______hours of experience with students
(K-8 or 7-12), under my supervision, during the period from_____________
to ________________.
Number of students:__Grade level of the classroom:___The time spent:___hours
per week
Name of school: _______________________________District: _____________
Types of activities in which the applicant participated:
Major strengths or skills observed which would predict teaching success:
(List and comment)
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