First Name: Last Name:   

Permanent Address: 
City: State: ALAKAZARCACOCTDCDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY Zip:
Phone:   Email:
Major: AccountingAmerican Indian StudiesArt EducationBiology EducationBusiness AdministrationBusiness EducationChemistry EducationCommunication ArtsEarly Childhood Special EducationElementary EducationEnglish EducationEntrepreneurial StudiesEnvironmental Physical ScienceHealth ServiceAdministrationHistory EducationHuman Resource ManagementHuman ServicesIndustrial Technology EducationMarketingMass CommunicationMathematics EducationMusic EducationOutdoorEducationPhysical EducationPhysical SciencePolitical ScienceProfessional AccountancyPsychologySocial Science EducationSociologySpanish EducationSpecial EducationSpeech TheatreTourism and Hospitality ManagementWellness Management

Do you want to be involved in the Rapid City or Pierre Project Select program? Rapid CityPierre

Please indicate the status of completion or term planned for completion.

• EDFN 385 - Pre Admission Practicum: YesNo Completion Date:
• EDFN 338 - Foundations: YesNo Completion Date:
• EPSY 302 - Ed Psych: YesNo Completion Date:
• EDFN 365 - Computer Based Technology: YesNo Completion Date:

ETS Praxis II Content Exam - Please indicate the following:

Have you taken a Praxis Content Exam in your major? YesNo
If yes, then please indicate which exam you took (# and title) and the score you received. 

• ETS content exam:  
• Score:

 Academic and Employment Background:

College and/or Universities Attended:

Name:	Dates:	Degrees:

You must submit official transcripts from all institutions by mail in addition to completing this application. 

Employment Record (List most recent employment first):

	Job Title	Employer/Address/Phone	Dates

Check those who may be contacted as references. 

 Obtain 3 letters of recommendation - send them to the following address:

Mary Goebel, Project SELECT Co-Director
College of Education
Black Hills State University
 Higher Education Center
515 West Blvd
Rapid City, SD 57701

 Please respond to the following questions:

1. Why do you want to be a teacher?
   
2. What events or circumstances have occurred in your life that are leading you to consider being a teacher?
   
3. List and describe the teaching experiences you have had (i.e., experience when you have helped an individual or group learn something).
   
4. What is effective teaching? 
   
5. Describe your favorite teacher.
   
6. Please list activities - organizations, volunteer work, service, etc. in which you have participated. Include dates.
   1. College:
      
   2. Civic, Professional:
      
   3. Volunteer, Service:
      
7. Please explain what goals you have for when you become a certified teacher. 
   1. For yourself:
      
   2. For your students:
      
8. Why does becoming a participant in Project SELECT appeal to you?