Master Math Teacher Certification Program Application Name_________________________ S.S.#______________ D.O.B___/ _ /__ Last

First

MI

required by SBEC

mm dd yy

Address_________________________ City_______________ Zip_______ Home Phone_____________________ Daytime Phone_________________ E-mail address____________________________ District_______________ Current Assignment_____________________________________________ Subject

Grade Level

School

Admission to the Region 12 Master Math Teacher Certification Program requires that all applicants meet the recognized and required standards as set by State Board for Educator Certification. Enrollment is limited, so applications will be reviewed by a screening committee. The Master Math Teacher Certification Program includes three certification levels. Please indicate your interest below.

EC-4

4-8

8-12

Application Process: The following materials must be submitted to the MMTCP Committee before the application will be considered:  A completed application form that describes applicant’s  impact on student mathematics achievement  professional development activities in the area of mathematics  completed college math courses (transcript not required)  participation in professional math organizations  awards and recognition in the area of math  participation in community service related to math (see following pages)  A letter of intent which includes the candidate’s background, teaching and career goals, and past and present teaching experiences in the area of mathematics  Three letters of recommendation: one from the District Superintendent, one from the Campus Principal, and one from someone familiar with the candidate’s academic abilities and experience in teaching math  Copy of valid Texas teaching certificate (Math Specialists must submit copy of Math Specialist Certificate)  Copy of Service Record verifying at least 3 years of teaching experience ESC 12/MMT Application/March 2011/Teach Learn-Gen Ed/Rev 5

Name______________________________ Undergraduate GPA _____

Masters GPA (if applicable) ________

Please describe your impact on student achievement in mathematics. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

Describe professional development activities in the area of mathematics you have attended. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

List completed college math courses. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________

ESC 12/MMT Application/March 2011/Teach Learn-Gen Ed/Rev 5

Name______________________________ List participation in professional math organizations. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________

List awards and recognition in the area of math teaching. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

Describe participation in community service related to mathematics. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

ESC 12/MMT Application/March 2011/Teach Learn-Gen Ed/Rev 5

Mail completed application and all documents to: MMTCP Committee Education Service Center Region 12 P.O. Box 23409 Waco, TX 76702-3409 Applications must be received at the ESC Region 12 Waco no later than April 24, 2017. (to arrive on or before April 24, 2017) Selection Process: Acceptance into the program is based upon review of completed application. Applicants will be notified of acceptance by letter.

ESC 12/MMT Application/March 2011/Teach Learn-Gen Ed/Rev 5