Professional Development and Provisional Licensure Coursework for Educators Application

All fields with an * are required.

Those seeking to meet VDOE professional studies requirements via coursework should not request a signed College Verification Form from the University of Richmond. Instead, please submit to VDOE a course description for any completed courses along with your UR transcript as proof of completion.

This form is for all applicants. We will send you your University of Richmond Student ID or reactivate your status if you have taken classes with us previously.

Program Information

Expected Start Term:*

Coursework/Certification/Endorsement Intentions

Please note that we offer coursework towards various areas of study, including coursework in support of provisionally licensed teachers as well as several add-on endorsements (gifted, ESL, and SPED) for fully licensed teachers

Applicant Information

First Name:*

Preferred First Name:

Middle Name/Initial:

Last Name:*

Date of Birth:*

Legal Sex:*

Contact Information

Email:*

Home Phone:*

Mobile Phone:*

Address:*

Country

Street

City

Region

Postal Code

Demographic Information

Are you a United States Citizen?*

Yes

No

Are you a Permanent Resident or Resident Alien?*

Yes

No

Please attach a copy of your permanent residency card.*

Native Language

What is your native language?*

Was your collegiate- or secondary-level instruction conducted in English?*

Yes

No

TOEFL Date:*

Please have official TOEFL scores sent directly to the University of Richmond (School Code: 5569). In the box above, please indicate the month and year that you took the TOEFL.

Ethnicity/Race (Optional)

Are you Hispanic/Latino?

Yes

No

Regardless of your answer to the prior question, please select one or more of the following ethnicities that best describe(s) you:

Employment

Employment Status:*

Employer:*

Business Phone:*

Address:*

Country

Street

City

Region

Postal Code

Educational History

You must have earned a bachelor's degree to be eligible for education professional development. We do not require transcripts, but please indicate your undergraduate degree and conferring institution.

School 1 (Required)

Institution:*
Please begin typing the name of your school below and, when possible, select your school from the list.

Your name when you attended:*

Degree:*

Dates Attended:*

to

Add Another School

School 2 (Optional)

Institution:*
Please begin typing the name of your school below and, when possible, select your school from the list.

Your name when you attended:*

Degree:*

Dates Attended:*

to

Add Another School

School 3 (Optional)

Institution:*
Please begin typing the name of your school below and, when possible, select your school from the list.

Your name when you attended:*

Degree:*

Dates Attended:*

to

Other Information & Registration Details

Have you ever taken courses in or been accepted into any program at the University of Richmond?*

Yes

No

Date Last Attended (or closest estimate):*

Last UR School Affiliation:*

Name when you attended:*

Have you ever been convicted of a crime other than a minor traffic violation?*

Yes

No

Please explain.*

As of July 1, 2006, Virginia law requires all public and private two-and-four-year institutions of higher education to electronically transmit information about applicants accepted for enrollment at each institution to the State Police for comparison to the Virginia Criminal Information Network and National Crime Information Center Convicted Sexual Offender Registry. If the University is notified that an admitted student has committed a sex offense, the admitted student is subject to the admission being revoked.

Signature

Digital Signature:*
By my signature below, I acknowledge that I am aware that I may enroll in a maximum of six semester hours each semester. I will be responsible for course registration in BannerWeb and payment of my tuition as well as any other related expenses to Student Accounts, and I agree to pay all reasonable collection costs including attorney fees and other charges necessary for the collection of this balance.

Please type your full legal name.

Click to Sign...