Probationary Principal or Superintendent Certificate

This form is necessary in determining a student’s eligibility for a Probationary Principal or Superintendent Certificate.
Please answer all questions completely.

Full Name: TSU Student ID Number:

For Principal applicants have you completed at least 24 hours of Educational Leadership coursework? Yes No

For Superintendent Applicants have you completed at least 15 hours of superintendence coursework? Yes No

Are you currently enrolled in an Internship/Practicum? ? Yes No

If yes, please indicate which course: supervised practicum EDA 6387 supervised practicum EDA 6388 superintendent internship EDA 6389

Do you currently have a administrative job or job offer? Yes No

If yes, for what position: Assistant Principal Principal Superintendent Central Office Administrator Instructional Coordinator Other

If other, please provide position title?

If yes for what School District?

If yes for what Campus?

If Grade levels you will be working with: Early childhood – Grade 4 Grades 4-8 Grades 8-12 Early childhood – Grade 12

Anticipated start date of employment?