University of Houston-Victoria :: Education & Human Development

Online Application

Please complete all of the fields as they are all required.

NAME
	First	Middle Initial	Last
ADDRESS
	Street Address

	City	State	Zip
TELEPHONE
	Home		Work

EMAIL

EDUCATIONAL DATA
Current Status: If you are co-enrolled at UHV and a community college, please check both boxes.
	Community College Student:
	UHV Student
	First Year Teacher/UHV Alumnus
Level at which you wish to become certified to teach:
Specialization:
Anticipated Student Teaching Semester
Status		Program
Of what professional organization(s) are you currently a member? Hold down the Ctrl key and click to select more than one.