Kinesiology and Community Health Physical Education Teacher Licensure Application Form

1. Name

2. UIN:

3. Local Address:

4. Local Phone:

5. Permanent Address:

6. Permanent Phone:

7. Illinois Email Address: answer must be an email address

8. Date of application:

9. Date when you took (will take) the Illinois Test of Academic Proficiency (TAP):

10. ACT/SAT Score:

11. Please upload a well-ordered essay that describes why you have decided to apply to the teacher education program. Please adhere to the following requirements when completing the essay: (a) no longer than one page, (b) double spaced, (c) 12 point font, and (d) one inch margins. The Committee is interested in how you express yourself as well as why you have elected to enter the teacher certification program. Therefore, your ability to communicate effectively will be evaluated as one component of your application. (maximum file size: 15MB)

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