TO:  Policy Studies Department - Admissions and Retention Committee:
 
FROM: Last name____________________________ First name   ______________________

S.S. No.  _______________________________         Phone ___________________________

Address  _________________________City ______________ Zip Code ________

PROGRAM:  BCLAD Multiple Subject

  Major:______________________________________

************************************************************************************
I am an applicant to the BCLAD Multiple Subject Program and would like to request the following:

Numerical Description for request(s) - Please check the appropriate number below:

____1. Course Waiver -     Based on equivalent course(s) within the last five years.
____2. Letter Grade C-    Previous Experience(s)
____3. Previous Experience - Experience in the classroom

Use the above numerical description to specify your type of request:

_____          PLC 515              ìBilingual Teaching Strategiesî
_____          ED 451                 ìIntroduction to Multicultural Educationî
_____          LING 420             ìLinguistics and English  or
_____          PLC400                " Secondary School and Bilingual Education"
_____          Other: __________________________

It is my understanding that the Admissions and Retention Committee will be reviewing the attached documentation for:

Course Waiver(s):             Transcripts and equivalent course description(s).
Letter Grade C-                 Transcripts to review my academic achievement/history
Previous Experience(s):    Transcripts and/or documents of my work/academic experience(s).
 

Please check for required attachements. Incomplete petitions ( with no attachments) will not be considered for review

Thank you for your cooperation
 

Signature__________________________  Date____________
9-97