This is only a Scholarship Application for the Non-Traditional Deaf Education Certification Program thru Region 17 ESC This application does not assure entry into Texas Tech University accepted January 7 - March 8, 2019 Applications Social Security # EDUCATION SERVICE CENTER Last Name First Name Middle Name University or Colleges Attended: Mailing Address Street City State Zip Permanent Home Address Street City State Zip Email Cell phone No. Non-Traditional Deaf Education Certification Yes No Valid Texas Teacher Certificate: Program for Teachers Yes No or more years teaching experience: Years Taught Types of Teaching Certificate: Closest Education Service Center School District Grade levels taught: None Beginning Intermediate Advanced Sign Language Skills: Copy of teaching certificate Submit the following to: Region 17 ESC Deaf Education Certification –  Program 1111 West Loop 289 Lubbock, TX 79416: • Completed application form (this brochure)  $50.00 application fee made out to: Region 17 ESC  Application - 1 page maximum Why I Would Be A Good Candidate For This Program  One letter of recommendation from school administrator TEA  One letter of recommendation from teaching colleague  Deaf Services
This is only a Scholarship Application for the Non-Traditional Deaf Education Certification Program thru Region 17 ESC This application does not assure entry into Texas Tech University Applications accepted January 7 - March 8, 2019 Social Security # EDUCATION SERVICE CENTER Last Name First Name Middle Name Mailing Address Street City State Zip Permanent Home Address Street City State Zip Email Cell phone No. Valid Texas Teacher Certificate: Yes No or more years teaching experience: Yes No Years Taught University or Colleges Attended: Non-Traditional Deaf Education Certification Program for Teachers Types of Teaching Certificate: Closest Education Service Center School District Grade levels taught: Sign Language Skills: None Beginning Intermediate Advanced Submit the following to: Region 17 ESC – Deaf Education Certification Program 1111 West Loop 289 • Lubbock, TX 79416:  Completed application form (this brochure)  $50.00 application fee made out to: Region 17 ESC  Application - 1 page maximum Why I Would Be A Good Candidate For This Program  One letter of recommendation from school administrator  One letter of recommendation from teaching colleague  Copy of teaching certificate TEA Deaf Services
Application%20-%20Deaf%20Ed.2018-2019.docx