Application for admission to the Teacher Education Program

Personal Information
Last Name *
First Name *
M.I. *
Maiden/former name(s)
Address *
City *
State *
Zip Code *
Home Phone *
Cell Phone *
Work Phone (Optional)
Drury e-mail address *
Drury ID
Date of Birth (mm/dd/yyyy)
 
Additional Information
Choose the primary campus location where you attend classes
Are you a U.S. Citizen or a permanent resident? (choose one)
Yes Not
Ethnic Status (optional, check all that apply)
African American
Asian American
Caucasian
Native American
Mexican American/Hispanic
Other
Classification (choose one)
Freshmen
Sophomore
Junior
Senior
Post-Baccalaureate
Area of Certification Desired:
Elementary Education (grades 1-6)
Middle School (grades 5-9)

- Post-baccalaureate only
- Completion in Springfield only

Troops to Teachers (grades 5-9)

- Post-baccalaureate only

Secondary (grades 9-12 or K-12)

- Completion in Springfield only

Criminal Record Check Release and Caregiver Background Screeing Release

I agree to complete the criminal background check located at www.dhss.mo.gov/FCSR (required payment and processing fee). I understand that the Drury University School of Education and Child Development will have access to the results of the check that will indicate any arrests, reports of sexual abuse, family violence, or child abuse my record may contain.

I also agree to release Drury University and its employees from future liability for any negligent act, omission, or fault arising from or related to this criminal record or background screeing check and any information contained in them. I do not, however, waive my rights to hold Drury University responsible for any harm caused by the intentional or grossly negligent conduct of its employees.

I understand that Drury University will use the information obtained from this criminal record check and caregiver background check to determine my eligibility for admission to the Teacher Education Program. Drury's consideration of my application to the program is offered in exchange for this release.

I agree to the criminal record check release and caregiver background screening release

Transcript and Data Release

I authorize the Drury University Registrar to prepare copies of my undergraduate and graduate transcripts to be included in my School of Education and Child Development file. These transcripts will be used in determining my eligibility for admission to the Teacher Education Program and for advisory purposes by the Director of the School of Education and Child Development. I also understand that the School of Education and Child Development is required to report annual data to the U.S. Department of Education and Missouri Department of Elementary and Secondary Education in accordance with Title II regulations. Information reported may include, and not be limited to, academic and demographic information (i.e. Social Security Number, standardized test results, gender and ethnicity).

I agree to the transcript and data release

I understand that the School of Education and Child Development is required to report academic and demographic data