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Declaration of Enrollment Form for the Undergraduate Teacher Preparation Programs

Department of Education and Human Development
The College at Brockport, SUNY

  • REMINDER: This enrollment form is ONLY for applicants who entered the college Fall 2015 semester or later. DO NOT complete this application unless you have applied to the college, been accepted AND deposited (paid your deposit) we are unable to review your application until that time.

    NOTE: Readmits to the College are subject to requirements based on the catalog year listed on the degree audit. Complete this form ONLY if your catalog year is 2015-16 or later.

  • I HAVE READ AND AGREE TO: *
    I HAVE READ AND AGREE TO:

    Read the program overview for the program you are enrolling in (Adolescence or Childhood)

  • I acknowledge the following is required for enrollment in the program I have applied for: *
    I acknowledge the following is required for enrollment in the program I have applied for:
  • Must be 9 digits.   Currently Entered: 3 digits.

    You must have applied to the college to have a banner ID

  • Date of Birth Date of Birth * / /
    Pick a date.
  • NAME: NAME: *
  • CURRENTLY ENROLLED AT BROCKPORT?: *
    CURRENTLY ENROLLED AT BROCKPORT?:
  • Was/Is your first semester at Brockport Fall 2015 or later? *
    Was/Is your first semester at Brockport Fall 2015 or later?
  • SUNY Requirements for Admissions to Education Programs

    Effective fall 2015 students entering the college must meet http://www.brockport.edu/admissions/101/freshman/education.html the SUNY System Board of Trustees additional requirements for admission to teacher preparation programs.

  • PERMANENT ADDRESS: PERMANENT ADDRESS: *
  • BROCKPORT CAMPUS or LOCAL ADDRESS (If different from above) BROCKPORT CAMPUS or LOCAL ADDRESS (If different from above)
  • PERMANENT PHONE: PERMANENT PHONE: * - -
  • CELL PHONE: CELL PHONE: - -
  • Application status and decision letters will be sent to email provided, please provide an actively used/monitored Brockport College or Personal (a non-college) email address.

  • Please enter your best total score for the ACT and SAT exams. If you did not complete the exam(s) please enter a 0.

  • PROGRAM APPLYING TO: (must indicate academic major) *
    PROGRAM APPLYING TO: (must indicate academic major)
  • ACADEMIC MAJOR ADOLESCENCE INCLUSIVE GENERALIST:
    ACADEMIC MAJOR ADOLESCENCE INCLUSIVE GENERALIST:

    Required completion or in progress of at least 15 credits in the academic major with a minimum 2.5 cumulative Brockport grade point average in the major

  • ACADEMIC MAJOR CHILDHOOD INCLUSIVE:
    ACADEMIC MAJOR CHILDHOOD INCLUSIVE:
  • *
  • Your application will be reviewed and you will receive a decision letter via email from the Department in 2-4 weeks. Please be sure that your email addresses in your banner account are updated and include a personal email address (a non-college email address) as well as your Brockport email.
    *
    Your application will be reviewed and you will receive a decision letter via email from the Department in 2-4 weeks. Please be sure that your email addresses in your banner account are updated and include a personal email address (a non-college email address) as well as your Brockport email.
  • Draw or Type
    I understand this is a legal representation of my signature. Clear
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