Admission Portfolio Cover Sheet
Five-Year Teacher Education Program
Rev. 8/15
Name ________________________________________________________________________
Summer Address________________________________________________________________
Phone ________________________________________________________________________
Student # _______________________________ Email address: _________________________
*High school attended _____________________________ County _______________________
*If you attended High School in Harrison, Marion, Monongalia, Preston or Taylor County in
WV, please also list the Elementary & Middle Schools you attended:_______________________
S
PECIALIZATION
_____ Elementary
(All elementary are grades K-6 multi-subjects.)
_____ 5-9 Math
(Please check the other required specialization that you are
_____ 5-9 Science
seeking.)
_____ 5-9 Social Studies
_____ 5-9 English
_____ 5-9 Spanish
_____ 5-9 French
_____ Pre K-K
_____ K-6 and 5-Adult Special Education
_____ Secondary
(Please check the specializations that you wish to pursue.)
_____ English 5-Adult
_____ Math 5-Adult
_____ Social Studies 5-Adult
_____ Sciences 5-Adult
_____ Biology 9-Adult
_____ Chemistry 9-Adult
_____ Physics 9-Adult
_____ Foreign Languages
_____ Spanish 5-Adult
_____ French 5-Adult
_____ German 9-Adult
Will you have use of a car during clinical placements?
Yes _____
No _____
Please list any information that you feel should be considered in determining your clinical
placements.