Intended Administrative Licensure Area
______________ Superintendent/Assistant Superintendent
______________ Principal/Assistant Principal
(please indicate level) _ Elem. _ MS _ HS
_______________ Special Education Administrator
______________ Supervisor/Director (please indicate subject)
For Office Use Only
_____ Date Received:
_____ Date Reviewed:
Admission to program ____ is ____ is not granted.
Participant Information
Full Name _______________________________________Social Security
Number: _______________________________________
Address (home) _______________________________________
_______________________________________
Telephone (home) _______________________________________
Email address _______________________________________
Address (work) _______________________________________
_______________________________________
Telephone (work) _______________________________________
Fax Number _______________________________________
Current position _______________________________________
How did you hear about this program? q
online q at school
q from a friend q Boston University q other
AApplication will not be considered until all of
the following requirements have been submitted
__________PERSONAL STATEMENT (1-2 pages)
Please address your motivation and preparation for educational
leadership and administration. In other words, why do you want
to enroll in this program?
__________RESUME
__________A COPY OF YOUR CURRENT TEACHING CERTIFICATE/LICENSE
__________A COPY OF THE MTEL RESULTS FOR THE COMMUNICATION
& LITERACY TEST AND
THE SUBJECT AREA TEST (If you have not yet received your score,
please indicate date of test (___/___/___).
__________OFFICIAL UNDERGRADUATE AND GRADUATE TRANSCRIPTS
__________TWO RECOMMENDATIONS (please use attached
forms):
(We trust that you will choose references who are able to address
your professional skills and leadership potential.)
__________ Other (colleague, professor, etc.)
__________$50 NON-REFUNDABLE APPLICATION FEE (Check
should be made payable to "The Education Cooperative.")