Academics ELE/SPED Application 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 * 2023 2024 2025 2026 2027 2028 2029 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 Alabama Alaska American Samoa Arizona Arkansas Baker Island California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Howland Island Idaho Illinois Indiana Iowa Jarvis Island Johnston Atoll Kansas Kentucky Kingman Reef Louisiana Maine Maryland Massachusetts Michigan Midway Atoll Minnesota Mississippi Missouri Montana Navassa Island Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palmyra Atoll Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands United States Virgin Islands Utah Vermont Virginia Wake Island Washington West Virginia Wisconsin Wyoming State Zip Campus * 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? Are you or your spouse an active duty US Military member? No Yes Are you currently employed full-time as a para-professional in a public school system? Are you currently employed full-time as a para-professional in a public school system? No 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.