ࡱ> c Sbjbj vff_ >>7777d7Gt7MMMMBBBQFSFSFSFSFSFSF$H8KwFQB=BBBwFMM%FFFFB MMQFFBQFFFFM(:B"F=FF0GFKBVKFKF<BBFBBBBBwFwFEBBBGBBBBKBBBBBBBBB> I: Graduate Students School Counselor Fax: (409) 880-1804  Certification Application for Graduate Programs Graduate Office Education. Rm. 201 C P.O. Box 10034 Beaumont, Texas 77710 Phone: (409) 880-2320 Graduate Office Use Only Approval date: Instructions: The application must be filled out completely and signed. Please FAX Application, Service Record and valid Texas Educator Certificate to the Graduate Office (409) 880-1804. If you have questions, call the above number, or email us at  HYPERLINK mailto:grad.certification@lamar.edu grad.certification@lamar.edu The applicant/educators name must appear exactly as it appears on their valid state ID. Name: Last First Middle Maiden SS# - - TEA# LU# Permanent Address: (Street or Box #) (Apt. #) (City, State, & Zip) Telephone Numbers: Date of Birth: (Month) (Day) (Year) Sex: Male Female Ethnicity: ( _)  - ( ) -  American Indian or Alaskan Native Home Cell E-mail Address (Print Clearly) Select one in each Area  Asian or Pacific Islander African-American (not of Hispanic origin) Hispanic White (not of Hispanic origin) Other 1. 2. MEd Program  Academic Partnership  3. School Counselor   1. Are you applying for a Probationary Certification? Yes No 2. Have you taken and passed your TExES exam? Yes No Date test taken: 3. Do you already hold a Masters Degree prior to this degree or certification? Yes No University/State Date degree awarded_ 4. Have you completed all coursework requirements for certification? Yes No Date coursework completed:  __________________________  Did you complete your internship in Texas? Yes  No School Name/District: _____________________ Internship Site Supervisor/Campus Role______________________________  There is an 8-week process to complete your application from the time the application is received and verified. I understand that I must pass the TExES exam. I understand that I must hold a conferred Master s degree before I can register for certification. I understand that all requirements for coursework are met according to my degree plan. 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