Note: An official copy of all transcripts is required for a program evaluation

Please do not complete this form more than once. If you'd like to re-establish contact with the NC TEACH office or update your licensure area/contact information, please call 828.227.7027.

Section 1: Contact Information

    First Middle Last Suffix
Name:

Former Names: (Other names that may appear on educational records)

  Month Day Year
Birthday:

 

Present Contact Information:

Address:
City, State, Zip: ,    
Primary Phone: () -
Alternate Phone: () -
Email Address:

 

Section 2: Alternative Licensure Program

We encourage you to select the licensure area that is most appropriate based on previous experience and your educational background. If multiple plans are requested, you will receive plans as they are completed. Please contact the Office of Alternative Licensure to check on the status of your application.

Please select up to two areas in which you wish to seek licensure:

First Choice
Second Choice

 

What semester will you begin your program:

I am applying to:

Alternative Licensure/NC TEACH : NC TEACH (North Carolina Teachers of Excellence for All Children) is an alternative teacher preparation program for recent college graduates, mid-career professionals and retirees.
NC TEACH II: Grant-funded project with a focus on recruitment and retention of highly qualified mid-career professionals and recent college graduates to high-need school districts. Upon making a commitment to remaining employed in a high-need district for at least three years, qualified program participants will receive a stipend of $3000. For more information, visit http://www.wcu.edu/8372.asp.
Temporary Student: A student following a plan of study from another university or the RALC may take licensure courses through Western’s NC TEACH program. Good standing at the former institution is required. Apply to WCU as teacher certification.

 

Section 3: Academic History

List all colleges and universities, starting with the most recent.

Institution Degree Major Overall GPA

 

Section 4: Employment Experience

Are you currently employed as a teacher in North Carolina?


If yes, indicate the district

and the name of the school:

 

Are you serving, have you served, or are you an immediate family member (spouse or child) of a current or former member of any branch of the United States Armed Forces (including the US Coast Guard)?

 

Section 5: Program Awareness

I heard about this program through:

If other, describe here:

 

Note: An official copy of all transcripts is required for a program evaluation

For more information, contact Rachel Wike