Application to Special Education Graduate Program

Name: __________________________________________________________ SSN: _________ ______ ____________

Address: ____________________________________________________________________________________________

_____________________________________________________________________________________________________

Telephone: Work: ( ) ______________ Home: ( ) ______________ e-mail: _________________________

Cell: ( ) ______________

Check the Graduate Area(s) You Are Interested in Pursuing at UNT

Generic Special Education for Students with Mild/Moderate Disabilities

___ Emotional and Behavioral Disorders
___ Learning Disabilities
___ Mental Retardation
___ Transition

Emotional and Behavioral Disorders

___ Autism
___ Juvenile Corrections
___ Transition

___ Educational Diagnostician
___ Gifted/Talented
___ Endorsement or Certification Only
___ Masters Degree
___ Doctorate Degree

Academic Preparation (list most recent first)

Degree  _____________________

Dates  _____________________

Institution  _____________________

Major/Minor  _____________________

Degree  _____________________

Dates  _____________________

Institution  _____________________

Major/Minor  _____________________

Degree  _____________________

Dates  _____________________

Institution  _____________________

Major/Minor  _____________________

Texas Certifications/Endorsements Currently Held (Attach copies for our files)

__________________________________________________________________________________________

Do you have a valid Texas teaching certificate with generic special education endorsement?
Yes No 
If yes, how was it obtained? Through University Coursework Through Alternative Certification

Professional Employment Record (list more recent first)

Dates From / To  ________ to ________

Position  ________________________

Employer  ________________________

If Special Education, What Type of Program  ________________________

Dates From / To  ________ to ________

Position  ________________________

Employer  ________________________

If Special Education, What Type of Program  ________________________

Dates From / To  ________ to ________

Position  ________________________

Employer  ________________________

If Special Education, What Type of Program  ________________________

When would you like to begin a taking graduate classes? ____________________________(Sem) (Yr) 

How would you attend? ___Full Time   ___Part Time 

To help us advise you better, tell us about your current professional goals. 

(Be concise, but specific. Use an additional sheet if needed.)

For those interested in pursuing the Educational Diagnostician Professional Certification:

Do you have three years successful teaching experience in special education and/or related area*? ___ Yes ___ No

If no, when will you have three years completed: ____________________________________________

*Note: The Special Education Faculty must review and approve all special areas submitted for consideration

Ethnic Background (optional):

American Indian or Alaskan Native Black, African America White, Non-Hispanic origin

Asian or Pacific Islander Hispanic Other: _________________________

Citizenship: _________________________ If not citizen of U.S., state INS status: ______________________

GRE Scores: V ___________ Q ___________ Total ___________

The GRE is required for Masters or Doctorate applicants and Educational Diagnostician Certification.

If you have not taken the GRE indicate date you plan to take the exam: __________________________

(For specifics on the admissions requirements see the current Graduate Catalog under Requirements for Admission to the Toulouse School of Graduate Studies).

Please submit the following with the completed application:

1. Copy of all transcripts.

2. Copy of teaching endorsements.

Mail application to: 
University of North Texas
College of Education
Programs in Special Education
P. O. Box 311335
Denton, Texas 76203

OR

Hand deliver to: 
Special Education Program,
Matthews Hall,
Room 304

940 565-2959 (voice)
940 565-2185 (fax)