The TOSS Application is not available until September 24, 2008. Please read below.

I. General Information

*Date:

*Legal Last Name:

*Legal First Name:

*Legal Middle Name:

*Called By:

*Date of Birth:

*KSU ID#:

*Your address during TOSS:

*Street Address:

*City, State Zip:

*e-mail address:
(KSU student e-mail only)

*Phone (Home):

Phone (Work or Cell):

*Semester and year you plan to take TOSS:

If you haven't been admitted to the Teacher Education Program, you are not eligible to take TOSS.

If you haven't been admitted to the Teacher Education Program, please explain why this is the case:

*You have passed GACE I Basic Skills Test (or Praxis I) or exempted it:

Click here for additional information about GACE I Basic Skills Test.

*You have passed GACE II (or Praxis II):

(To pass GACE II, you must score at least 220 on test I (001) and at least 220 on test II (002) For more information about GACE II, click here. You do not need to have passed GACE II to be admitted to TOSS. This question is for data gathering only.

II. Advisor Information

Before you can be admitted into the TOSS program, you must consult (either in person or via e-mail) with an advisor to be sure you have completed all requirements for TOSS. Please click below on the advisor with whom you consulted prior to completing this application. An e-mail will be sent to the advisor for confirmation. Note, no student will be admitted to TOSS without that advisor's approval.

*Date of meeting:

*Current GPA:

*Planned Program: Write in the courses you are currently taking or plan to take beginning this semester through your anticipated graduation .

Semester/Year:

III. Verification of Liability Insurance

As part of my professional preparation, I understand that I will be assigned for certain laboratory experiences in school systems beyond the university campus. I am further aware that the following statement is a part of the State Department of Education Guidelines for Professional Laboratory Experiences in Georgia Teacher Education.

"Liabilty-Prior to professional laboratory experiences placement, students must provide evidence of having adequate tort liability insurance or waive such coverage in writing." As systems with which KSU has agreements for placing students require liability insurance, I have obtained coverage.

I (type your name in the box) * , verify that I have tort liability insurance as follows:

* (Name of Company or Organization)

* (Amount of coverage) * (Dates of coverage)

* (Membership/Policy Number)

You can obtain liability insurance simply by joining either GAE or PAGE. Information about each organization can by found in the TRACK Center or outside of the Center for Field Experiences and Partnerships (3219 Kennesaw Hall).

IV. Preferences of Times for TOSS Classes

Why?:

V. Information for Field Placement

The information provided below will be used by the principals in your TOSS field schools to help them make decisions about placement.

*Which subject(s) are you most excited about teaching? (For the next two items, it is a good idea to write your responses in Word using the spelling and grammar check feature. Then copy and paste your responses in the provided spaces.)

*Which subject(s) are you most concerned about teaching?

List any teaching experience, the grade level, and length of time you worked at that level.

Grade Level:

Length of time:

*Grade level preference for TOSS. (Remember placement is up to the principals in the schools. This is only a suggestion. It does not guarantee you placement in any grade level.)

VI. Emergency Contact Information

*In case of emergency, contact:

*Relationship to emergency contact:

*Phone number of emergency contact:

*Physician's Name:

*Physician's Phone:

*Are there any special medical conditions of which professors and cooperating teachers should be aware? If so, please identify appropriate emergency intervention strategies.

This application will be e-mailed to Dr. Steffen and back to your e-mail address. Please check the e-mail for accuracy and keep it for your records.