ࡱ> ] ybjbjRR 78$b8$bz r r 8:k.L}L!L#-------$1m4-E#}}##-%.%%%#R-%#-%%VV,@, $R, -;.0k.,T4a$4,4,##%#####--%###k.####4#########r B :  College of Education 215 Ball Hall Ƶ, TN 38152 Phone: 678-2363 Instruction and Curriculum Leadership Applicant Information for Education Specialist Application Deadlines: Fall - April 1 Spring - October 1 Summer- February 1 *IDT Deadline February 1Name:  FORMTEXT Last name, First name Middle name   SSN: FORMTEXT xxx - xxx - xxxSemester Applying For: FORMDROPDOWN Address:  FORMTEXT       FORMTEXT City  FORMTEXT State FORMTEXT Zip codeName on University Records: FORMTEXT      Email: FORMTEXT      Phone: FORMTEXT      List Colleges Attended: Full Name of College Degree Earned Major  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       Concentration Area and Emphasis:  FORMCHECKBOX  Early Childhood  FORMCHECKBOX  Instructional Design and Technology*  FORMCHECKBOX  Reading  FORMCHECKBOX  Special Education:  FORMCHECKBOX  Applied Behavior Analysis Fall Only Admission  FORMCHECKBOX  Early Childhood  FORMCHECKBOX  Modified  FORMCHECKBOX  Comprehensive  FORMCHECKBOX  Instruction and Curriculum:  FORMCHECKBOX  Elementary/Middle  FORMCHECKBOX  Instruction and Curriculum  FORMCHECKBOX  Secondary  FORMCHECKBOX Elementary/Middle Test Information: Taken GRE: Yes - List Scores Verbal:  FORMTEXT       Quantitative:  FORMTEXT       Writing:  FORMTEXT       No - When do you plan to take it?  FORMTEXT       Where did you learn about the ICL EdS program? Check all that apply: FORMCHECKBOX  A friend or family member  FORMCHECKBOX  ICL Website  FORMCHECKBOX  RecruitmFGm ͬ׆t_M;Mt#h*.B*CJOJPJQJaJph#hyHB*CJOJPJQJaJph)h_ hyHB*CJOJPJQJaJph#h4vB*CJOJPJQJaJph,h_ h4v5B*CJOJPJQJaJphhoKhyHCJOJQJaJ,h_ hSg5B*CJOJPJQJaJphhcqh~26PJhcqhyH6PJ,h_ hyH5B*CJOJPJQJaJphhcqh4vPJhcqhyHPJ$6FGm$d$&`#$/Ifa$gd$$Ifa$gd4v$$Ifa$gd4v$d$&`#$/Ifa$gd $$&`#$/Ifa$gd4v v\B($d$&`#$/Ifa$gd$d$&`#$/Ifa$gd~4$d$&`#$/Ifa$gd kd$$Ifl4`0 \(`* t 6`044 layt  \F$&`#$/Ifgdkd$$Ifl40 \( * t 6`044 layt$d$&`#$/Ifa$gd        = > A B C D I J һt[F+5jh_ hyH5B*CJOJPJQJUaJph)h_ hyHB*CJOJPJQJaJph1h t5B*CJOJPJQJaJmHnHphu5jVh t5B*CJOJPJQJUaJph&h t5B*CJOJPJQJaJph/jh t5B*CJOJPJQJUaJph,h_ hyH5B*CJOJPJQJaJphhcqhyHPJhoKhyHCJOJQJaJ)hh4vB*CJOJPJQJaJph  ? @ A B C d$&`#$/IfgdC D I g Q;$d$&`#$/Ifgd$&`#$/Ifgdkd$$Ifl7\4D]!\( t 6`044 laytJ T U V e f g ~  ˰s_Ds5hoKhyHCJOJQJaJ5jh4v5B*CJOJPJQJUaJph&h4v5B*CJOJPJQJaJph/jh4v5B*CJOJPJQJUaJphhcqhyHPJ7h_ hyH5B*CJOJPJQJaJmHnHphu5jh_ hyH5B*CJOJPJQJUaJph;j.h_ hyH5B*CJOJPJQJUaJph,h_ hyH5B*CJOJPJQJaJphg ~ -kd`$$Ifl7\4D\([   t 6`044 laytd$&`#$/Ifgd $Ifgd  4 6 ^ d$&`#$/Ifgd$&`#$/Ifgd   $ & ( 0 2 6 8 L Ѵx]B+,h_ hyH5B*CJOJPJQJaJph5jh_ hyH5B*CJOJPJQJUaJph4h_ hyHB*CJOJPJQJaJmHnHphu8jh_ hyHB*CJOJPJQJUaJph=jh_ hyHB*CJOJPJQJUaJmHnHphu8jh_ hyHB*CJOJPJQJUaJph)h_ hyHB*CJOJPJQJaJph2jh_ hyHB*CJOJPJQJUaJphL N P Z \ ^ ` t v x ƪƓydGy,y4h_ hyHB*CJOJPJQJaJmHnHphu8jh_ hyHB*CJOJPJQJUaJph)h_ hyHB*CJOJPJQJaJph2jh_ hyHB*CJOJPJQJUaJph,h_ hyH5B*CJOJPJQJaJph7h_ hyH5B*CJOJPJQJaJmHnHphu5jh_ hyH5B*CJOJPJQJUaJph;jph_ hyH5B*CJOJPJQJUaJph >($&`#$/Ifgdkdr$$Ifl7r,j \(  t 6`044 layt  ܽi`?#7h_ hyH5B*CJOJPJQJaJmHnHphu@jh_ hyH5B*CJOJPJQJUaJmHnHphuhcqhyHPJ,h_ hyH5B*CJOJPJQJaJphCjh_ hyHB*CJOJPJQJUaJmHnHphu4h_ hyHB*CJOJPJQJaJmHnHphu=jh_ hyHB*CJOJPJQJUaJmHnHphu)hcqhyHB*CJOJPJQJaJphhoKhyHCJOJQJaJ & 4 \ `J$&`#$/Ifgdkd $$Ifl70 \(  t 6`044 laytd$&`#$/Ifgd  $ 4 6 J L Z \ ^ ܻdULBU(2jhvUhyHB*CJOJPJQJUaJphhhyH0J5hcqhyHPJhoKhyHCJOJQJaJFjb h_ hyH5B*CJOJPJQJUaJmHnHphu7h_ hyH5B*CJOJPJQJaJmHnHphu,h_ hyH5B*CJOJPJQJaJph@jh_ hyH5B*CJOJPJQJUaJmHnHphuFj h_ hyH5B*CJOJPJQJUaJmHnHphu \ ^ Q5$d$&`#$/Ifa$gd~4kd $$Ifl7\4J\(~ t 6`044 layt +kd $IfK$L$l`F)`'$|  t0    44 lapyt,N$d$&`#$/Ifa$gd~4K$   " $ . 0 2 4 H J L V X Z \ ^ r ͳwZKhoKhyHCJOJQJaJ8j hvUhyHB*CJOJPJQJUaJph8jO hvUhyHB*CJOJPJQJUaJph=jhvUhyHB*CJOJPJQJUaJmHnHphu2jhvUhyHB*CJOJPJQJUaJph8j hvUhyHB*CJOJPJQJUaJph)hvUhyHB*CJOJPJQJaJph 2 Z \ Skd;$IfK$L$lF)`'$| t0    44 layt,Nd$&`#$/Ifgd~4K$r t v ɪɕɕxɪɕɕ[ɪɕLɕhoKhyHCJOJQJaJ8jhvUhyHB*CJOJPJQJUaJph8jKhvUhyHB*CJOJPJQJUaJph)hvUhyHB*CJOJPJQJaJph=jhvUhyHB*CJOJPJQJUaJmHnHphu2jhvUhyHB*CJOJPJQJUaJph8jhvUhyHB*CJOJPJQJUaJph & N lSSSd$&`#$/Ifgd~4K$kd7$IfK$L$l`F)`'$| t0    44 layt,N    " $ & ( < > @ J L N P R ɪɕɕxɪɕɕ[ɪɕL9$h_ hyH5B*OJPJQJphhoKhyHCJOJQJaJ8jhvUhyHB*CJOJPJQJUaJph8jGhvUhyHB*CJOJPJQJUaJph)hvUhyHB*CJOJPJQJaJph=jhvUhyHB*CJOJPJQJUaJmHnHphu2jhvUhyHB*CJOJPJQJUaJph8jhvUhyHB*CJOJPJQJUaJphN P R lL.$d$&`#$/Ifa$gd~4K$ $ Vl&d$&`#$/Ifgd~4kd3$IfK$L$l`F)`'$| t0    44 layt,NR 6:@AOPQ\ɲɲɲvɲbɲDɲ;j<hhyH5B*CJOJPJQJUaJph&h5B*CJOJPJQJaJph;jhhyH5B*CJOJPJQJUaJph;jThhyH5B*CJOJPJQJUaJph,hhyH5B*CJOJPJQJaJph5jhhyH5B*CJOJPJQJUaJph$hoKhyH5B*OJPJQJphhcqhyHPJ 7@[mMm6d$&`#$/Ifgdo $ Vl&d$&`#$/Ifgdo! $ Vl&d$&`#$/IfgdoK$qkd$IfK$L$l`'[' t044 lap yt,N[\]E$! $ Vl&d$&`#$/IfgdoK$kd$IfK$L$lFN `'I j t0    44 lapyt,Nd$&`#$/IfgdoK$\]^lmnoηηmSm6Sm8jhoKhyHB*CJOJPJQJUaJph2jhoKhyHB*CJOJPJQJUaJph)hoKhyHB*CJOJPJQJaJph,hhyH5B*CJOJPJQJaJph;jmhoKhyH5B*CJOJPJQJUaJph,hoKhyH5B*CJOJPJQJaJph5jhoKhyH5B*CJOJPJQJUaJph,hoKh5B*CJOJPJQJaJph! $ Vl&d$&`#$/IfgdoK$ $ Vl&d$&`#$/Ifgdo֫ydGyd0,hoKhyH5B*CJOJPJQJaJph8jWhoKhyHB*CJOJPJQJUaJph)hoKhyHB*CJOJPJQJaJph2jhoKhyHB*CJOJPJQJUaJph/hhyH56B*CJOJPJQJaJph,hhyH6B*CJOJPJQJaJph&h6B*CJOJPJQJaJph,hh6B*CJOJPJQJaJph#hB*CJOJPJQJaJph g^=! $ Vl&d$&`#$/Ifgd0p>K$! $ Vl&d$&`#$/Ifgd~4K$kd$IfK$L$lFN `'I j t0    44 lapyt,N'()ghvwxҸiN0N;j1hoKhyH5B*CJOJPJQJUaJph5jhoKhyH5B*CJOJPJQJUaJph8jhoKhyHB*CJOJPJQJUaJph8jhoKhyHB*CJOJPJQJUaJph)hoKhyHB*CJOJPJQJaJph2jhoKhyHB*CJOJPJQJUaJph,hoKhyH5B*CJOJPJQJaJph,hoKh5B*CJOJPJQJaJphg;kdp$IfK$L$l%FN `'I j t0    44 lapyt,N! $ Vl&d$&`#$/Ifgd0p>K$ "ӹꜹcO:(#h,NB*CJOJPJQJaJph)h,Nh0p>B*CJOJPJQJaJph&h0p>5B*CJOJPJQJaJph;jhoKhyH5B*CJOJPJQJUaJph5jhoKhyH5B*CJOJPJQJUaJph8jhoKhyHB*CJOJPJQJUaJph2jhoKhyHB*CJOJPJQJUaJph,hoKhyH5B*CJOJPJQJaJph)hoKhyHB*CJOJPJQJaJph8! $ Vl&d$&`#$/Ifgd0p>K$! $ Vl&d$&`#$/IfgdoK$"68:<>վձՍճվ>)󱹱*䴳ʴϴ8o*䴳ʴϴ8᳢o*䴳ʴϴ2o*䴳ʴϴ,o5B*䴳ʴϴ,o5B*䴳ʴϴ)o*䴳ʴϴ),*䴳ʴϴ8:<v^=&d$&`#$/Ifgd0p>! $ Vl&d$&`#$/Ifgd~4K$kd$IfK$L$lFN `'I j t0    44 lapyt,Nvx$kd8$IfK$L$lFN `'I j t0    44 lapyt,Nd$&`#$/Ifgd0p>! $ Vl&d$&`#$/Ifgd0p>K$ d$&`#$/Ifgd~4K$d$&`#$/Ifgd~4d$&`#$/Ifgd~4VXln|ԿcI,II8joh#hyHB*CJOJPJQJUaJph2jh#hyHB*CJOJPJQJUaJphCjh#hyHB*CJOJPJQJUaJmHnHphu4h#hyHB*CJOJPJQJaJmHnHphu=jh#hyHB*CJOJPJQJUaJmHnHphu)h#h#B*CJOJPJQJaJph)h#hyHB*CJOJPJQJaJph,h#hyH5B*CJOJPJQJaJph  ~վvgPg47jhNB*CJOJPJQJUaJmHnHphu,h#hyH5B*CJOJPJQJaJphhoKhyHCJOJQJaJ7jhyHB*CJOJPJQJUaJmHnHphu2jhyHB*CJOJPJQJUaJph#hyHB*CJOJPJQJaJph,jhyHB*CJOJPJQJUaJph)hvUhyHB*CJOJPJQJaJph)h#hyHB*CJOJPJQJaJph  \;;;!d$&`#$(d/IfRgd~4K$kd[$IfK$L$lF !B`'!  t0W'    44 lapyt,N\;!d$&`#$(d/IfRgd~4K$kdY$IfK$L$lF !B`'!  t0W'    44 lapyt,N02468ɭyr`K4,hvUhyH5B*CJOJPJQJaJph(hoKhyH5B*CJOJQJaJph"h5B*CJOJQJaJph hcqh~2 hcqhd& hcqhyHhoKhyHCJOJQJaJ,h#hyH5B*CJOJPJQJaJph7jhNB*CJOJPJQJUaJmHnHphu=je hNB*CJOJPJQJUaJmHnHphu.hNB*CJOJPJQJaJmHnHphu2{a$d$&`#$/Ifa$gd~4$d$Ifa$gd~4skd $IfK$L$l% `'W' t0W'44 lap yt,N246sd$&`#$/Ifgd~4tkd!$$Ifl\(( t 6`044 layt68(tptt$uxusssseeJ$&`#$-D/IfM gd~4d$Ifgd~4d$&`#$/Ifgd~4tkd!"$$Ifl\(( t 6`044 layt8:VXZ\t(t*tFtHtJtntptrttݸywaRh~4h~4CJOJQJaJ+j$h~4hyHCJOJQJUaJU+j#h~4hyHCJOJQJUaJ+j3#h~4hyHCJOJQJUaJ%jh~4hyHCJOJQJUaJh~4hyHCJOJQJaJ+j"hoKhyHCJOJQJUaJhoKhyHCJOJQJaJ%jhoKhyHCJOJQJUaJent Fair/Convention  FORMCHECKBOX  Recruitment Email FORMCHECKBOX  Web advertisement  FORMCHECKBOX  Facebook, Twitter, Instagram, etc.  FORMCHECKBOX  Other, please describe:  FORMTEXT      This application will not be processed until the following requirements have been submitted: Online Application to  HYPERLINK "https://banssbprod.memphis.edu/pls/PROD/bwskalog.p_disploginnew?in_id=&cpbl=&newid=" Graduate Admission with Official Transcripts from all Institutions Attended Official GRE Scores  Test scores older than 5 years will not be accepted Two Letters of Recommendation Resume 500 to 1000 Words Written Statement All requirements are due by the application deadline.     Revised 01/28/15 tttttttt$u&uBuDuFuuuuuuuuuDZǞycJ5(hZEhyH5B*CJOJQJaJph0jhZEhyHCJOJQJUaJmHnHu+j%hZEhyHCJOJQJUaJ+j%hZEhyHCJOJQJUaJhZEhyHCJOJQJaJ%jhZEhyHCJOJQJUaJ+j %hoKhyHCJOJQJUaJhoKhyHCJOJQJaJ%jhoKhyHCJOJQJUaJ+j$hoKh1CJOJQJUaJxuuu|vxx\B00 & Fd$Ifgd~4$d$&`#$/Ifa$gd~4kdm&$$Ifl0\( t 6`044 layt$&`#$-D/IfM gd~4uuzv|vvvlwnwwwxxx^xxxxxx2y4yyyyƻvvaJ,h~4hyH5B*CJOJPJQJaJph)h_ hyHB*CJOJPJQJaJphh~4hOJQJh~4OJQJhOJQJ!jhh0JOJQJUhh0JOJQJhjhUhhOJQJ&hyH5B*CJOJPJQJaJph,h_ hyH5B*CJOJPJQJaJphhoKhyHCJOJQJaJxxx2y4yyyyC>gdtkdA'$$Ifl\(( t 6`044 layt$ d$&`#$/Ifa$gd~4d$&`#$/Ifgd~4 & Fd$Ifgd~4yyyyyyyyyyyyyyh1hLh16CJhcqjhcqUhvUheCJOJQJaJ yyyyyyyyyyyyygdd 5 01h:p/ =!"#$% $$If!vh#v*#v:V l4` t 6`0+5*5yt$$If!vh#v*#v:V l4 t 6`0+5*5/ ytDText1"Last name, First name Middle name $$If!vh#v#v#v#v:V l7 t 6`0,5555/ / / / /  / / ytDxxx - xxx - xxxDf Dropdown1 FallSpringSummer$$If!vh#v#v#v[ #v :V l7 t 6`0,555[ 5 / / / / / / / yttDText2|DText3City~DText4StateDText5Zip code,$$If!vh#v#v#v #v#v:V l7 t 6`0,555 55/ / / / / / / yttDText6$$If!vh#v #v:V l7 t 6`0,5 5/  / / / yttDText7tDText8$$If!vh#v#v#v~#v:V l7 t 6`0,555~5/ / / / / / / yt$IfK$L$q!vh#v$#v#v| :V l`  t05$55| pyt,NtDText9vDText12vDText14$IfK$L$q!vh#v$#v#v| :V l t05$55| yt,NvDText10vDText13vDText15$IfK$L$q!vh#v$#v#v| :V l` t05$55| yt,NvDText11vDText17vDText16$IfK$L$q!vh#v$#v#v| :V l` t05$55| yt,N$IfK$L$q!vh#v[':V l t05['p yt,NtDeCheck1tDeCheck3tDeCheck5$IfK$L$q!vh#vI #vj#v :V l t0,5I 5j5 pyt,NtDeCheck2vDeCheck12tDeCheck6$IfK$L$q!vh#vI #vj#v :V l t0,5I 5j5 pyt,NtDeCheck7tDeCheck8$IfK$L$q!vh#vI #vj#v :V l% t0,5I 5j5 pyt,NtDeCheck9vDeCheck10tDeCheck9$IfK$L$q!vh#vI #vj#v :V l t0,5I 5j5 pyt,NvDeCheck11vDeCheck10$IfK$L$q!vh#vI #vj#v :V l t0,5I 5j5 pyt,NvDText18vDText19vDText20$IfK$L$u!vh#v#v! #v :V l t0W',55! 5 / / / / apyt,N $IfK$L$u!vh#v#v! #v :V l t0W',55! 5 / / / / / apyt,NDText21M/d/yy$IfK$L$u!vh#vW':V l% t0W'5W'/ ap yt,N$$If!vh#v(:V l t 6`05(/ yt$$If!vh#v(:V l t 6`05(/ ytvDeCheck13vDeCheck14vDeCheck15vDeCheck16vDCheck17vDeCheck18vDeCheck19vDText22$$If!vh#v#v:V l t 6`055/ / / / yt$$If!vh#v(:V l t 6`05(/ / yt s666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666666866666662 0@P`p(2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p(8HX`~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ OJPJQJ_HmH nH sH tH N`N +Normal dCJPJ_HaJmH sH tH ^@^ 4v Heading 1$<@&"5CJ KH OJPJQJ\^JaJ `@` 4v Heading 2$<@&$56CJOJPJQJ\]^JaJZ@Z 4v Heading 3$<@&5CJOJPJQJ\^JaJDA`D Default Paragraph FontRi@R 0 Table Normal4 l4a (k ( 0No List R^@R +0 Normal (Web) dCJOJQJ^JaJ> @> +0FooterdH$:/: +0 Footer Char CJPJaJR"R +0 Balloon Text dCJOJQJ^JaJR/1R +0Balloon Text CharCJOJPJQJ^JaJjCj vU Table Grid7:V0>R> 0Header !d:/a: 0 Header Char CJPJaJV/qV 4vHeading 1 Char"5CJ KH OJPJQJ\^JaJ X/X 4vHeading 2 Char$56CJOJPJQJ\]^JaJR/R 4vHeading 3 Char5CJOJPJQJ\^JaJ.X@. @Emphasis6]T`T  List Paragraph ^m$OJ PJ QJ ^J6U`6 0 Hyperlink >*B*phPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vc:E3v@P~Ds |w< , ! J L  r R \"8tuyy  "%')+-1259=?A C g \ N [g8v 26xuxyy !#$&(*,./034678>@B=IUe~ '39BNT %'39;GMs8H0@dtS_ezDTp:Jt^ q FFS FFFFFFFFFFFFFFFFG$G$G$G$G$G$G$G$G$G$G$G$G$FFFFG$G$G$G$G$G$G$FX8@0(  B S  ?)Text1 Dropdown1Text2Text3Text4Text5Text6Text7Text8Text9Text12Text14Text10Text13Text15Text11Text17Text16Check1Check3Check5Check2Check12Check6Check7Check8Check9Check10Check11Text18Text19Text20Text21Check13Check14Check15Check16Check17Check18Check19Text22 (C(<t91eT{Eq;u   !"#$%&'(>:U&:NI AufUK !z | }  y|z | }  3ooPPQQ ! y y l[5`nL. J}8{ ^`OJQJo( 8^8`OJQJo(^`OJ QJ ^J o(o  p^ `OJ QJ o(  @ ^ `OJ QJ o( x^x`OJQJo(H^H`OJ QJ ^J o(o ^`OJ QJ o( ^`OJ QJ o( ^`OJQJo(^`OJ QJ ^J o(o p^p`OJ QJ o( @ ^@ `OJQJo(^`OJ QJ ^J o(o ^`OJ QJ o( ^`OJQJo(^`OJ QJ ^J o(o P^P`OJ QJ o(h^`OJQJo(hHh^`OJ QJ ^J o(hHohp^p`OJ QJ o(hHh@ ^@ `OJQJo(hHh^`OJ QJ ^J o(hHoh^`OJ QJ o(hHh^`OJQJo(hHh^`OJ QJ ^J o(hHohP^P`OJ QJ o(hH}5`nL                  &#~2'=1N#*.0p>ZE GoK7%WYn_@hT%oru4vyHo-Rl_ cq t+e ,Nsx~4zvUd&Sgz | @y y y y @{@ `@` `@``tUnknown G*Cx Times New Roman5Symbol3.*Cx Arial3*Ax TimesA. Trebuchet MSC.,{ @Calibri Light7@CambriaG=  jMS Mincho-3 fge PLucida GrandeArial Unicode MS7.@Calibri?= *Cx Courier New;WingdingsA$BCambria Math q'hcc!20u u K#QHP $P'+*! xxo ,Studio Graduate AssistantShelby Lynn Tate (state1)   Oh+'0|  8 D P\dltStudio Graduate AssistantNormalShelby Lynn Tate (state1)3Microsoft Office Word@^в@V@A՜.+,D՜.+,@ hp  University of Ƶu   Title( 8@ _PID_HLINKSAh{oThttps://banssbprod.memphis.edu/pls/PROD/bwskalog.p_disploginnew?in_id=&cpbl=&newid=  !"#$%&'()*+,-./0123456789:;<=>?@ABCEFGHIJKLMNOPQRSTUVWYZ[\]^_`abcdefghijklmnopqrtuvwxyz|}~Root Entry FP@Data D'1TableX5WordDocument 7SummaryInformation(sDocumentSummaryInformation8{MsoDataStore@ TLQVSE0D0QBZFA==2@ Item  PropertiesUCompObj r   F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q