Seacoast Montessori Teacher Education Program Application

In hiring, promotion, and provision of training we do not engage in any form of discrimination based on race, religion, sex, origin, disability, age, or gender identity.

Last Name*

First*

E-mail:*

Program Location*

Bluffton SCHaverhill MANeedham MAOther

Level*

EC (2.5-6)EL I (6-9)EL II (9-12)Other

Your address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Are you a citizen on the United States?*

YesNo

Phone Number*

Area CodePhone Number

If no, please give country and see acknowledgement before submitting form.

Level of Education*

Year Completed*

Degree granted by*

Major/Concentration

Level of Education

Year Completed

Degree granted by

Major/Concentration

Do you have a MACTE-accredited Early Childhood Credential?*

YesNo - I understand that I will need an Early Childhood Overview before I can be recommended for certification.I am applying to the EC level and no Overview is required.

If Yes, Credential issued by:

Year

If applying for EL II only and you already hold an accredited EL I credential, provide the following information:

Program

Year Granted

Portions of this program are delivered via distance. Please indicate your comfort level.

I have taken online coursework previously.I am comfortable in basic use of mobile phone, computer, and or tablet technology.I may need support in understanding specific programs or tools but am willing to tryOther

Institution*

Last Employment

Street Address

CityState / Province

Postal / Zip CodeCountry

Check if this is your practicum site:

Yes

Administrator/Contact

Phone Number

Area CodePhone Number

Full Name*

First NameLast Name

E-mail

Full Name*

First NameLast Name

E-mail

Full Name*

First NameLast Name

E-mail

Form of payment*

by purchase order or checkinvoice my schoolcredit card (Please call our business office for instructions.)

School contact name for invoice:

Email

example@example.com

School Contact telephone

Area CodePhone Number

I certify that the above information is correct to the best of my knowledge. I authorize Seacoast Center for Education to contact my references for further pertinent information regarding my candidacy. I further recognize that Seacoast Center for Education cannot guarantee employment or salary upon completion of this program and release it from liability for circumstances arising from relationships between my practicum site and myself. I understand that upon enrollment full tuition is due notwithstanding any payment plan agreements I may enter into with Seacoast Center for Education, and that should I not complete the course(s) in which I enroll for any reason refund of tuition will be in accordance with published policies of Seacoast Center for Education as prescribed by the State of New Hampshire. For citizens of countries outside the U.S.: I understand it is my responsibility to establish eligibility to study and/or work in the United States and not that of Seacoast Center for Education and that evaluation of degrees issued outside the US is required by AMS and MACTE at my own expense.

Full Name*

First NameLast Name

Date*

Application Fee

Application Fee$175.00

Please read carefully before submitting.

Total $0.00

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Montessori Teacher Education Program Application

Education

Most recent employment

References

Application Fee Payment

Acknowledgement by the applicant

Cancellation

Submit application