Application for Educator Licensure and Preparation Program

Secondary Program (Middle School or High School)

Cell phone
Campus phone
Year of graduation
Overall GPA
Education GPA
License sought:
Bio 8–12
Chemistry 8–12
Earth Science 8–12
English 5–8
English 8–12
History 8–12
Humanities 5–8
Math 5–12
Middle School Math & Science 5–8
Physics 8–12
Please check all core licensure classes (or approved equivalent) that you have completed thus far:
EDC 211 Sheltering Instruction
EDC 232 American Middle and High School
EDC 238 Intro to the Learning Sciences
EDC 342 Growing Up American
EDC 347 Individual Differences Among Learners
Will you have a car available for your use while student teaching?
According to your records what courses do you have left to take— in education and in your major?
Please list all experiences that you have had working with children, including those conducted as part of your service learning/prepracticum requirements in Smith College classes.
Experience 1
Details of placement
Experience 2
Details of placement
Experience 3
Details of placement
As you potentially approach a student teaching experience, what do you see as your strengths as a future educator, and which areas do you think will be important areas to work on?

Next steps for completion of application and acceptance into preparation program:

  1. Immediately upon submitting this application, you must send an up-to-date unofficial transcript copy to and
  2. Your adviser within the department and the coordinator of teacher education will initially review your application and your progress towards licensure requirements
  3. You will be asked to attend an interview with members of the department, at which you will also be asked to perform a ten-minute mini lesson, appropriate to the subject area and grade range that you wish to teach.

Please print this page before sending it to the Department of Education and Child Study so that you have a copy for your records.