Application for Innovate Admission: Teacher Preparation Program

Teacher Certification Preparation Program

Application for Admission (Undergraduate). You may save your progress at the bottom of the form by pressing "Save."
Name*

First NameMiddle NameLast Name
HU ID # (If you do not have an HU ID # yet, please leave blank)
Phone Number*

Area CodePhone Number
Alternative Phone Number

Area CodePhone Number
Email*
example@example.com
Alternative Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Demographic Information
The College of Education at Heritage University is required by the Washington Professional Education Standards Board (PESB) and our accrediting bodies to collect the following demographic information. The submitted demographic information will not be considered in regards to admission into the program.
Date of Birth*

MonthDayYear
Date
Gender Identity*

MaleFemaleNon-BinaryPrefer not to Answer
Is English your first language?*

YesNo
Are you a First Generation College Student?-A student is considered first generation if the parent(s) the student lives (lived) with the majority of the time has (had) not attained a Bachelor's degree (while the student lived with them).*

YesNo
Select a general ethnicity and/or heritage background with which you identify.*

African/BlackAsian/Pacific IslanderCaucasian/WhiteHispanic/Latin-DecentIndigenous PeoplesMulti-RacialPrefer not to Respond
African/Black*
Please select the ethnicity option with which you most closely identify. Options are listed Alphabetically.
Asian/Pacific Islander*
Please select the ethnicity option with which you most closely identify. Options are listed Alphabetically.
Caucasian/White*
Please select the ethnicity option with which you most closely identify. Options are listed Alphabetically.
Hispanic/Latin-Decent*
Please select the ethnicity option with which you most closely identify. Options are listed Alphabetically.
Indigenous Peoples*
Please select the ethnicity option with which you most closely identify. Options are listed Geographically (Washington, Oregon and Idaho tribes first) and Alphabetically.
Multi-Racial*
Please select the ethnicity option with which you most closely identify. Options are listed Alphabetically.
If you do not find the ethnicity/background you identify with, please type in an option(s) that best represent you.
Academic Information
Which Campus are you interested in?*

ToppenishTri-cities
If we are allowed to be face-to-face by all entities and all health department requirements are met, what would your preferred method of instruction be?*

Face to Face- All class sessions will be held in the classrooms with recorded lessons for students who choose to stay home for health reasons (i.e., no live synchronous option available).Hybrid/Synchronous Online- Your attendance would be synchronous (i.e., sign-on to class at designated weekly time) while live class sessions are held in Topppenish at the same time. Recorded lessons will be offered via myheritage.
Anything else we need to know in terms of your preferences?
Undergraduate Endorsement Option (Select all options you are interested in)*

Elementary Education (Grades K-8) and English Language Learner (Grades K-12)Middle Level Math (Grades 4-9) (Toppenish Undergraduate Only)Middle Level Humanities (Grades 4-9) (Toppenish Undergraduate Only)Secondary Education Area (Grades 5-12) (Toppenish Undergraduate Only)
Content Area*
(UG Only) Did you earn your AA-DTA or complete your GUCRs (30 Semester or 45 Quarter credits)?*

YesNo
(UG Only) Where did you complete your AA-DTA or last 30 semester/45 quarter credits?*
(UG Only)When will or when did you complete your GUCRs at Heritage University or your AA-DTA at another institution?

MonthDayYear
Date

Testing Competencies

Teacher Preparation program candidates must attempt the WEST B, SAT, or ACT (all three subtests) before enrolling in the first semester of the undergraduate education program.
Basic Skills Test

WEST-Bs, SAT, or ACT (Reading, Math, Writing)
Have you taken the WEST B, SAT or ACT?*

If no, enter your scheduled test date(s). We will consider you for interviews prior to your completed test dates AS LONG AS THEY ARE SCHEDULED. You may sign-up here for the WEST-B exams: http://www.west.nesinc.com/TestView.aspx?f=HTML_FRAG/WA095_TestPage.html*
Test Score Reports or Test Date Confirmation Emails

Upload your Test Score Reports. If you have not taken the WEST-B, SAT, or ACT, you must schedule to take one of the exams and upload the Test Date Confirmation Email here PRIOR TO BEING CONSIDERED FOR INTERVIEWS.
Upload WEST-B Scores or Test Date Confirmation Email
Upload SAT Scores or Test Date Confirmation Email
Upload ACT Scores or Test Date Confirmation Email

Additional Required Documents
Statement of Goals

Upload a Letter of Application including the below requirements
Write a letter of application for admission to the program. It should be a maximum of two, typed double-spaced pages and include the following:
- Explain the reasons for your interest in teaching (focus on school settings).
- Describe experiences with children (especially expereinces in school settings).
- Describe your special knowledge, skills or experience (i. e. bilingual, math/science background, work with special needs students, etc.).
Upload your Letter of Application*

Browse Files

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Resume

Upload your most recent resume
Upload your Resume*

Browse Files

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WATCH Form -

Complete and upload your WATCH form
To complete the WATCH form (which is a basic background check) complete the following steps:

1. Download a copy of this WATCH form (click on the "download" button next to the "print" button)

2. Complete the form to the best of your ability

3. Sign by typing in your name or inserting your signature

4. Upload your completed copy below.
Upload your completed WATCH form (refer to instructions above)*

Browse Files

Cancelof

VACCINATIONS AND FIELD PLACEMENTS

As you are most likely aware, Washington now requires all state employees to be fully vaccinated by Oct. 18, 2021. Any teacher candidates placed in a school district for the purpose of an internship, student teaching, or practicum, must abide by this same rule.

Heritage University policy regarding COVID-19 vaccination status clearly requires that all students be fully vaccinated. You will find the link to the Heritage University policy below. We would like to direct you to the specific language applicable to placement in school districts per Heritage University Policy.

Accredited programs, extracurricular programs/activities, or academic programs that place students in other organizations such as hospitals, schools, or State agencies may have strict vaccination requirements. Such organizations may also need to comply with State mandates or other policies adopted during the pandemic. As such, Heritage University officials have the right to disclose privately to faculty chairs a student's vaccination status. Students that have an approved exemption from Heritage University should in no way assume those exemptions are valid at other organizations. Heritage University has no jurisdiction over such organizations and students who are seeking an exemption for placement in those organizations must comply with those requirements and procedures. Students that have valid medical and religious exemptions are also not guaranteed placement at those sites given Heritage University students are considered guests. (Link: https://heritage.edu/coronavirus/ )

A failure to comply with the state’s requirements will result in the prevention of future placements in our partner school districts.

Please follow this link to upload documentation of vaccination directly to Heritage University: https://myheritage.heritage.edu/ICS/Students/Student_COVID_Information.jnz
I acknowledge and will comply with the above vaccination mandate in accordance with Washington state requirements (you will not be able to continue with this application without agreeing to the above statement). If you have questions or concerns, please direct them to collegeofed@heritage.edu.*

Yes, I acknowledge and will comply with the above vaccination mandate.
Certification of Responsibility

Because of the responsibility of members of the teaching profession to the total development of young people, and notwithstanding a student's enrollment in or graduation from the College of Education, the dean and the faculty of the College reserve the right to refuse to admit to a teaching program, or recommend a student for a teaching certificate or endorsement if, in the discretion of the dean and the faculty, such a recommendation or assignment would be contrary to or, in violation of WAC 181-79A-155 - Good Moral Character and Personal Fitness.
(Type your full name) *

First NameMiddle NameLast Name
I, {name}, declare under penalty of purjury under the lasw of the State of Washington that the foregoing is true and correct.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

	WEST-B	SAT	ACT
DATE TAKEN
READING
WRITING
MATH

Teacher Certification Preparation Program

Demographic Information

Academic Information

Testing Competencies

Basic Skills Test

Test Score Reports or Test Date Confirmation Emails

Additional Required Documents

Statement of Goals

Resume

WATCH Form -

Certification of Responsibility