Dear Prospective Student:

(1)

Dear Prospective Student:

Thank you for your interest in our School Counseling (K-8 and 7-12) certification programs at Missouri State University. By completing the following application materials, you will be admitted to Missouri State University as a post-masters, non-degree seeking student, and we will establish a certification file for you in the Teacher Certification Office. This will allow our office to track your progress toward certification once fully admitted to the counseling program.

Once we receive all of your application materials and an official transcript from every College or University you have attended, we will complete an “Individualized Program of Study” (IPS) for you. This document will describe all coursework you will be required to complete for

certification as a school counselor or Psychological Examiner, and will be used by both you and your assigned advisor when discussing registration for courses.

You will be advised by a faculty member in the Counseling Department. Once admitted, you will be assigned an advisor by that department. However, questions specifically about

certification may be directed to me by calling the Teacher Certification Office at 417-836-8772 or by emailing me at: [email protected]

Best of luck as you pursue this academic program!

Sincerely,

Scott Fiedler

Director of Student Services – Certification Officer

(2)

CERTIFICATION CHECKLIST

In order to be recommended for certification at the end of your academic

program, all of the following must be submitted to the Teacher Certification

Office:

_____ Program Declaration Form

_____ Transcript Analysis Request Form

_____ Transcript Analysis Fee ($50.00)

_____ Transcripts from every institution (college or university) you have

ever attended, (except Missouri State and MSU – West Plains) even

if those courses have been transferred to another institution or

appear on your Missouri State transcript.

(3)

Instructions to Complete this Packet

Program Declaration Form:

Use this form to indicate which area or areas of certification you wish to pursue. This will determine which Individualized Program of Study we complete for you, and which area of certification we will recommend you for when you finish your program. If you decide later to add an additional area of certification, or if you decide not to pursue an added area that you put on this form, just call our office and ask us to make that change to your record.

Transcript Analysis Request Form:

Please complete this entire form. This information is needed for us to enter you into our Teacher Certification Database, to admit you to Missouri State University, and to track your progress toward certification.

Transcript Analysis Fee:

This fee is required of every student who establishes a file in the Teacher Certification Office.

The Transcript Analysis Fee for all students pursuing Counseling certification is currently $50.00.

This can be paid by cash, check, money order or you can call 417-836-8772 and pay over the phone with a credit card. You do not have to pay additional fees for adding other areas of counseling certification.

Transcripts:

In order to recommend you for certification in Missouri, we need an official transcript from every college or university you have ever attended regardless of whether those courses were transferred to another institution, were required for certification, or were required for your program. These transcripts will be sent to the Department of Elementary and Secondary Education (DESE) when we recommend you for certification.

Please use the enclosed form to request your transcripts. This form should be sent to each institution you have attended. They will then send the transcript directly to our office. We will request your Missouri State transcript.

(4)

Questions? Please call 417-836-8772 and ask to speak with:

Scott Fiedler

Director of Student Services – Certification Officer

Please return all materials to the Teacher Certification Office in the enclosed return envelope, or you can mail it to our office at:

Teacher Certification Office 901 S. National Ave.

Springfield, MO 65897

(5)

TEACHER CERTIFICATION OFFICE

PROGRAM DECLARATION FORM

For Students with a Related Master’s Degree

NAME _____________________________________ SS# __________________________

My Master’s Degree is in: ________________________________________________________

I earned my Master’s Degree at: __________________________________________________

Year completed: ____________________________

I INTEND TO PURSUE THE FOLLOWING CERTIFICATION AS MY PRIMARY PROGRAM AT MISSOURI STATE (Please check only one):

_____ SCHOOL COUNSELING (K-8) _____ SCHOOL COUNSELING (7-12)

_____ SCHOOL PSYCHOLOGICAL EXAMINER (K-12)

I ALSO INTEND TO ADD THE FOLLOWING CERTIFICATION(S) TO MY PRIMARY PROGRAM:

(please check all that apply) _____ SCHOOL COUNSELING (K-8) _____ SCHOOL COUNSELING (7-12)

_____ SCHOOL PSYCHOLOGICAL EXAMINER (K-12)

___________________________________________ ______________________________

STUDENT SIGNATURE DATE

(6)

Application for Post-Baccalaureate Admissions

and Teacher Certification Transcript Analysis

APPLICANT INFORMATION (please print) Last

Name: First

Name: M.I.: All Maiden or Former Names:

Mailing Address:

County: City: State: Zip:

Work

Phone: Home

Phone: Cell

Phone:

Email

Address: *SSN: Date of Birth: / /

*Disclosure of your social security number (SSN) is required. If you provide your SSN, it will be used for various administrative purposes at the University. It is required for certification with the Department of Elementary and Secondary Education.

Have you ever been convicted of or pled guilty to a crime other than a traffic offense or are any criminal charges pending against you, or have you been dismissed/suspended from another college or university for disciplinary reasons?

YES NO (If yes explain on separate sheet.)

Do you currently hold a teaching certificate in any area? YES NO If yes, what state? __________________________________

If you are currently certified, please provide a copy of your teaching certificate with this application.

Are you a citizen of the United States? YES NO Is your legal residence in Missouri? YES NO

Ethnic Status

(optional/for statistical reporting only)

African American European American Asian American Mexican American/Latin Native American American/Hispanic Other __________________________

If yes, how long? More than a year Less than a year

If not a Missouri resident, of what state and county are you a resident?

COLLEGE OR UNIVERSITY ENROLLMENT HISTORY (please print)

List ALL accredited colleges and universities from which you have earned credit (including Missouri State), even if credits were transferred to another institution. All original, official transcripts are required by the Teacher Certification Office to complete the transcript analysis

(official transcripts are in a sealed envelope from the college or university when received in the Teacher Certification Office).

Received College Name City/State Degree(s) Awarded

SIGNATURE

I certify that the information I have provided is accurate and acknowledge that falsified information may result in suspension from Missouri State University with loss of fees. I also agree that I am subject to the University’s policies, rules and requirements applicable to students including, but not limited to, those stated in the University catalogs, class schedules, computer use policies and the Student Code of Rights and Responsibilities.

Student’s Signature _______________________________________________________________ Date ________/________/________

FOR OFFICE USE ONLY Analysis

Fee: $ Date Received / / Credit Card: Visa Master Card Cash Check #___________

Processed by: Date: / / M

DB Admit Notes:

This form is both your application to Missouri State University as a Post-Bac, teacher certification student and your request for an Official Transcript Analysis from the Teacher Certification Office. If you are applying to a graduate program, you must also complete that application process separately.

(7)

Name

Last First M.I.

Address Street

City State Zip

Social Security Number

Birthdate Month/Date/Year Phone Number

( )

All other names under which you may have enrolled:

Signature

Please send my official transcript to: Teacher Certification Office Missouri State University 901 S. National Ave.

To: Records Office

College or University Last Term and Year Attended

❏ Fall ❏ Spring ❏ Summer Year Number of copies to be sent Check one of the following:

❏ Mail immediately

❏ Mail after current term grades are posted

❏ Mail after degree is posted

Please complete this form and mail it to the records office of the previous institution(s) attended. Many schools require fee payment with transcript requests. Transcripts must be sent directly from the previous institution(s) to Missouri State to be considered official.

Your transcript analysis will not be processed until all official transcripts arrive.

Transcript Request Form

For students seeking Post-Baccalaureate Teacher Certification at Missouri State University_™

Name

Last First M.I.

Address Street

City State Zip

( )

Signature

To: Records Office

Name

Last First M.I.

Address Street

City State Zip

( )

Signature

To: Records Office

▼Provided below are forms to use to request your official academic transcript(s) to be mailed directly from your previous college(s) to Missouri State University's Teacher Certification Office.

1