Graduate Dual Credit Teaching Certificate Application

First Name*

Middle Name

Last Name*

Gender

Female

Male

Birthdate*

Citizenship*

Country of Birth*

Contact

Email Address*

Home Phone

Cell Phone

Do we have your permission to send you text updates?

Yes

No

Address

Permanent Address*

Country

Street

City

Region

Postal Code

Do you have a different mailing address?*

Yes

No

Enter your mailing address if different than permanent.

Mailing Address

Country

Street

City

Region

Postal Code

ENROLLMENT INFORMATION

In which semester do you plan to begin your program at St. Mary's?*

Planned Course of Study*

Why do you wish to pursue the Graduate Certificate in Dual Credit Teaching and how do you see yourself activating this certificate in your professional life? The response should not exceed 500 words.*

What do you hope to learn in the Dual Credit Certificate Program? The response should not exceed 500 words.*

Are you currently a teacher? If yes, please describe your current teaching role. The response should not exceed 500 words.*

U.S. Veteran or Military Status

Are you a current employee with the Department of Defense?

Yes

No

Are you or were you a member of the U.S. Armed Forces?

Yes

No

As a member of U.S. Armed Forces, you must submit your military transcripts that reference all traditional academic training done on active duty.
If you are a member of the Army, Marine Corps, Navy, or Coast Guard, you must submit your Joint Services Transcript.
If you are member of the Air Force, you must submit a transcript from the Community College of the Air Force.

Please select which military branch you are a member of:

St. Mary's can request your joint services transcript on your behalf from the American Council on Education (ACE). Do you give us permission to request your Joint Services Transcript from ACE on your behalf? (Your social security number must be entered under the tab Biographical Information of this application.)

Yes

No

Please select which of the following:

Active

Active Reserved

Retired

Veteran

Are you a dependent/spouse of a U.S. Armed Forces member?

Yes - Dependent of Armed Forces member

Yes - Spouse of Armed Forces member

No

Will you be utilizing any third-party or VA educational benefits?

Yes

No

Education Information

Name of highest Degree Granting Institution:*

CEEB Code

Level of Study

Undergraduate

Graduate

Please upload transcript from Highest Degree Granting Institution:

Please upload one Letter of Recommendation

Uploaded transcript is classified as an unofficial document. I am aware that I must request an official transcript from my Graduate Degree Granting Institution.*

FELONY INFORMATION

Have you ever been convicted of a felony?*

Yes

No

If yes, please explain.

DISCLOSURES

St. Mary's University is an equal education opportunity institution. The University's admission standards and practices are free from discrimination on the basis of age, sex, race, creed, color, disability, ethnicity or national origin.

In Compliance with Title IX, St. Mary’s University does not discriminate on the basis of sex in the education programs or activities it operates. Questions regarding Title IX may be referred to the St. Mary’s University Title IX Officer or to the Office of Civil Rights, U.S. Department of Education.

St. Mary’s University is committed to assisting all members of the community in providing for their own safety and security. The Annual Security and Fire Safety Report is available online. If you would like a hard copy of the report, stop by the St. Mary’s Police Department Office at One Camino Santa Maria, San Antonio, Texas 78228 or request a copy be mailed to you by calling 210-436-3330.

The report contains information, required by law, regarding campus security and personal safety. The report also contains information about fire statistics in campus residential facilities and crime statistics for the three previous calendar years that occurred on campus; property owned or controlled by the University; and public property within, or immediately adjacent to and accessible from the campus.

Information regarding graduation and retention rates is available online.

CERTIFICATION

By submitting this application you agree to the following:

I certify that all the information given on this application is complete and correct to the best of my knowledge and that I have not attended institutions other than those listed. I understand that I am responsible for the forwarding of official transcripts from schools that I have attended, and that such transcripts become the property of St. Mary's University and will not be returned. I understand that any false or misleading statements that will be considered just cause for admission denial or immediate dismissal, if the student is enrolled.

Graduate Dual Credit Teaching Certificate Application

Application Instructions: