Principal Licensure Program Application

Semester applying for: *

Contact Information

Email address: *

Your Name

First name: *

Middle name:

Last name: *

Preferred first name:

Birthdate

Birthdate:

Permanent Address

Street address:

City:

State:

Zip code:

County (Ky. residents only):

Phone Numbers

Home phone:

Work phone:

Cell phone:

Fax number:

Current Employment

Place of employment:

Position:

Address:

Birth Place

City:

State:

Country:

Country of Citizenship

Country:

Type of visa:

Gender/Ethnic Origin(optional)

Asbury University is asked to report gender and ethnic origin data on applicants. Response to these requests is optional; however, we would ask that applicants volunteer this information. This information will be used for state and federal statistical reporting purposes, and will not in any way be part of the University's admissions decision with regard to the applicant.

Gender:

Ethnic origin:

Academic Information

Chronologically list all colleges and universities attended or attending. Include the following information:

Dates attended
Location of school (city and state)
Degrees or credits earned
Indicate if you were ever dismissed or suspended

Please request all institutions to send official college transcripts to: Graduate Education Program, Asbury University, One Macklem Drive, Wilmore, KY 40390

Colleges and universities:

Area of Interest

Indicate the graduate area of interest for which you are applying:

Choose one::

Principal Licensure Program, Rank I (Master's Degree and teacher certification required)

Single course or non-degree seeking - 9 hours maximum (No intent to pursue a degree at this time)

Certification

Will your Asbury University degree/hours be applied toward Rank I status?:

Yes

Please list any certifications you have in the box below. Include the following information:

Area
Date of Expiration
Type of Certificate
State of Issuance

Certifications:

Community Expectations

Asbury University is a Christian, liberal arts institution. No official denominational emphasis exists at Asbury University and those of all denominational backgrounds may participate fully in the spiritual life of the campus. The institution maintains a doctrinal commitment to an evangelical Wesleyan-Arminian perspective. We are committed to academic excellence and spiritual vitality for a lifetime of learning, leadership, and service to the professions, society, family, and the Church.

Please read Asbury's Community Expectations (see downloadable PDF.)

Community expectations: *

Are you willing to abide by these guidelines during enrollment at Asbury University?

Denomination

What is your denominational preference or affiliation?:

Other Information

How did you hear about Asbury University?:

Why did you select Asbury University?:

Accuracy of Information

Legal statement:

I hereby make application to Asbury University and certify the truthfulness of the answers given herein. I understand that I am responsible for arranging the forwarding of official transcripts of all schools I have attended or am attending and official scores of national tests I have taken or will take. Such documents become the property of Asbury University and will not be returned to me.