Special Education Administrators Application to Off-campus Cohort

1. Applicant information

First Name *This question is required.

MI

Last Name *This question is required.

Social Security Number *This question is required. This is a secure form This question requires a valid number format.

Street Address *This question is required.

Apt/Suite/Office

City *This question is required.

State *This question is required.

Zip *This question is required.

Email *This question is required.

Phone *This question is required.

If yes, when?

State of Legal Residency *This question is required.

For how long?

2. Education

Space Cell	College/University	Degree	Major	Date conferred	GPA
1	College/University	Degree	Major	Date conferred	GPA
2	College/University	Degree	Major	Date conferred	GPA
3	College/University	Degree	Major	Date conferred	GPA
4	College/University	Degree	Major	Date conferred	GPA

3. Certification you already have, required

Base certificate

Added endorsements if any

District/School (if applicable)

Copy of education and professional certification.Upload 2 items. 1) a copy of your graduate degree transcript, and 2) a copy of your professional certification. OR you can send these after you complete this application. If you received your degree from RIC, we will add your transcripts to your file for you. Just upload or send the professional certification document. You must hold at least certification (for 3 years) in ONE of the following areas to be eligible for RIDE approval: 1. Special Education Teacher, or 2. Speech and Language Pathologist, or 3. School Social Worker, or 4. School Psychologist.

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