GPS KSOE Bilingual Certificate Program Application (External Applicants ONLY)

Intended Term of Enrollment

Summer 2024 - The Priority Application deadline for the summer term is February 1, 2024, and the final deadline is May 1, 2024.

Apply for the Saint Mary's College KSOE Bilingual Authorization Certificate Program.

Personal Information

First Name*

Preferred Name

Last Name*

Personal Email* (for registration confirmation; do not use work email, due to firewalls)

Mobile*

Phone*

Birthdate*

Mailing Address*

Country

Street

City

Region

Postal Code

Ethnicity*

Federal guidelines mandate that we collect data on the legal sex of all applicants. Please report the legal, biological sex as indicated on your birth certificate. Additionally, we encourage you to share your gender identity and gender pronouns in the comments section below.

Gender - Legal, Biological Sex (as indicated by your birth certificate)*

Gender Identity

Pronouns

SMC Graduate*

SMC ID Number, if an SMC Graduate

Employment

Do you hold a preliminary or clear credential?*

Preliminary Credential

Clear Credential

When did you receive your teaching credential?

What kind of credential do you hold?*

Multiple Subjects

Education Specialist

Single Subject

Other

If Single Subject, which subject?

If Other, which type of credential do you hold?

What is the Document Number of your credential, as shown on the CTC's web site?

Are you currently teaching in a bilingual classroom?

Yes

Why are you interested in the Bilingual Added Authorization program?*

Agreement

The above information is true and correct. In place of your signature, please type your full legal name:*