ELE/SPED Application - Admissions - South Georgia State College

Teacher Education Application ELE/SPED Program

Please fill out the form below. Required fields are indicated with a * symbol. Thank you.

Application Information

Admit Term: Fall *

Full Name - If no middle name, enter "none." *

First Name

Middle Name

Last Name

Date of Birth * Month, Day, Year (05/01/1995)

SGSC Student ID# *

Full Address *

Address Line 1

Address Line 2

City

State

Zip

Campus *

Douglas

Waycross

Coastal Pines transfer

Wiregrass transfer

Cell Phone Number *

Alternate Phone Number

SGSC Email Address

Other Email Address

In case of emergency notify: * Include full name, phone, relationship

Are you or your spouse an active duty US Military member?

Yes

Are you currently employed full-time as a para-professional in a public school system?

Yes

If yes, enter School Name & County

Please indicate any specific childcare location emergency, SGSC Athletic involvement or serious medical condition (providing documentation) that should be considered for Field Placement location.