Provisional Form

Name Name * First Middle Last
Campus Email *
Phone Phone - ### - ### ####
Current GPA *
Term requesting provisional approval *

Term requesting provisional approval Spring Summer Fall
Year requesting provisional approval *
Have you ever received provisional enrollment or been issued permission codes to enroll in classes? *

Have you ever received provisional enrollment or been issued permission codes to enroll in classes? yes no
How many times have you received a previous provisional approval? *
Please provide the term and reason for your first provisional enrollment approval *
Please provide the term and reason for your second provisional enrollment approval *
Please provide the term and reason for your third provisional enrollment approval *
Please provide the term and reason for your fourth provisional enrollment approval *
Please specify how many times and the terms in which you have received provisional approvals *
Please select your Major/Endorsement. *

Please select your Major/Endorsement. Early Childhood Education Early Childhood Education Inclusive Endorsement (B-3) Early Childhood Education Supplemental Endorsement (PK-3) Elementary Education Endorsement (K-8) English as a Second Language Supplemental Endorsement (ESL) (PK-12) Middle Level Endorsement (5-9) Secondary Education Endorsements (6-12, 7-12) Special Education Endorsement (K-12) Special Education Endorsement (K-6) Special Education Endorsement (7-12) Health and Physical Education Endorsement (PK-12) Athletic Coaching Supplemental Endorsement (7-12)
Advisor *
If you are majoring in Middle Grades or Secondary Education, please select your second Advisor.
Specify Advisor if not listed in drop down menu above
I have not been admitted to Teacher Education due to the following:

Check ALL that apply and enter the required information.
Dispositions

Dispositions disposition notices or social probation
GPA

GPA have less than 2.75 GPA
English Composition Course

English Composition Course have not completed an English composition course or have a grade less than a "C"
English Composition Course Grade-or indicate current enrollment *
Math Course

Math Course have not completed a Math course (Math 110 or above) or have a grade less than a "C"
Math Course Grade-or indicate current enrollment *
EDUC 208/209

EDUC 208/209 have not successfully completed EDUC 208/209
EDUC 208/209 Grade-or indicate current enrollment *
EDUC 255

EDUC 255 have not successfully completed EDUC 255
EDUC 255 Grade-or indicate current enrollment *
PSYC 250

PSYC 250 have not successfully completed PSYC 250
PSYC 250 Grade-or indicate current enrollment *
SPED 200

SPED 200 have not successfully completed SPED 200
SPED 200 Grade-or indicate current enrollment *
Are you a transfer student completing your first term? *

Are you a transfer student completing your first term? yes no
I confirm that I have passed all 3 Praxis Core tests. *

I confirm that I have passed all 3 Praxis Core tests. Yes No

*If you have not passed all 3 Praxis Core tests you are NOT eligible for a provisional enrollment.
Praxis Core Reading Score *
Praxis Core Writing Score *
Praxis Core Math Score *
Please enter the complete course information for each of the courses you are requesting this semester. Include all of the following:
Call # (23487);
Course ID (EDUC 300);
Section # (00A);
Course title (Classroom Management & Effective Teaching).

*You may NOT enroll in EDUC 400
Course 1 Call #
Course 1 ID
Course 1 Section
Course 1 Title
Course 2 Call #
Course 2 ID
Course 2 Section
Course 2 Title
Course 3 Call #
Course 3 ID
Course 3 Section
Course 3 Title
Course 4 Call #
Course 4 ID
Course 4 Section
Course 4 Title
Course 5 Call #
Course 5 ID
Course 5 Section
Course 5 Title
Course 6 Call #
Course 6 ID
Course 6 Section
Course 6 Title
Upload a Copy of Your Four Year Plan *

Attach Files
Write a brief statement to the Dean of Education containing details of your plan for completing the requirements for admission to teacher education during the provisional semester. *
Carefully Read and Agree to this Section

Please accept this e-form as a formal appeal for provisional enrollment to Teacher Education for ONE TERM so that I can enroll in restricted education classes.
I am aware of the fact that this provisional is good for one term only and if the deficiency is not eliminated during the term granted, I will not be able to continue in any upper division restricted courses until being officially admitted to Teacher Education.
*

I agree
Draw your signature into the box below. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

Provisional Form

Provisional Form

I have not been admitted to Teacher Education due to the following:

Please enter the complete course information for each of the courses you are requesting this semester. Include all of the following: Call # (23487); Course ID (EDUC 300); Section # (00A); Course title (Classroom Management & Effective Teaching). *You may NOT enroll in EDUC 400

Carefully Read and Agree to this Section

Please enter the complete course information for each of the courses you are requesting this semester. Include all of the following:
Call # (23487);
Course ID (EDUC 300);
Section # (00A);
Course title (Classroom Management & Effective Teaching).

*You may NOT enroll in EDUC 400