EPI Application

Thank you for your interest in the Educator Preparation Institute (EPI) at Palm Beach State College.

We hope that you have watched both videos before beginning the application process. There, you will find information about our program and answers to most, if not all, of your questions. Proceed to the application if you are ready to continue. Otherwise; return to our webpage to watch the videos.

*Required fields

I. Demographic Information:

PBSC Student ID*

PBSC Student Email*Please use your @my.palmbeachstate.edu email address

Prefix*

Last Name*

Middle Name (not initial or maiden)

First Name*

Primary Phone*xxx-xxx-xxxx

Alternate Phonexxx-xxx-xxxx

Alternate Email Address*

Street Address*

Address Cont’d

City*

State*

Zip/Postal Code*

County*

II. Education History:

If your degree was obtained from outside the U.S., transcripts must be accompanied by a course-by-course evaluation from an academic credential-evaluating agency prior to applying to the Educator Preparation Institute (EPI).

BA/BS Degree

BA/BS CUM GPA*

Major*

Date Awarded*

Institution*

III. Florida Teacher Certification Exams (FTCE):

General Knowledge Test

Date Passed Essay*

Date Passed English*

Date Passed Reading*

Date Passed Math*

Subject Area Exams

Subject Area 1

Date Passed Subject Area 1

Professional Education Test (PED)

Date Passed PED

IV. Statement of Status of Eligibility (SOE):

Subject Area 1*

Date Issued*

Expiration Date*

V. Temporary Certificate (if applicable):

Subject Area 1

Date Issued

Expiration Date

VI. Teaching:

Teaching Experience (if applicable): Which of the following best describes you?*

If you are currently teaching, please complete the information below.

Name of School:

Hire Date

End Date

Grade Level

Subject Area

VII. Misc.:

Referral source: How did you find out about the program?Use CTRL + mouse to choose more than one answer

If you answered "other", please tell us how you found out about the program.

Acknowledgement: By submitting this application, I understand that...

...I am responsible for adhering to all Palm Beach State College policies (i.e. admission, registration, drop/withdrawal, and standards of academic progress)*

I agree

...as part of the EPI program, I am responsible for program, course, and field practicum requirements.*

I agree

...as part of the EPI program, I must observe a Clinical Educator (CE) in my subject area for a minimum of thirty (30) hours.*

I agree