Traineeship Application Form Summer 2023 Application "*" indicates required fields Hiddenyear Hiddenterm Hiddenentry_revision Hiddenrevision_app_id Request_IDApplicant Name*(Legal name required- as it appears on your teaching certificate) First Last University Student ID*(Not a Social Security#) HiddenFolder ID Applicant Home Address* Street Address City State ZIP / Postal Code Applicant Preferred Phone*Applicant School District Email*(NOT a personal email - example: [email protected]) District Name* School Name/Building* School Phone*Grade Level Teaching* Current Teaching Area* LBD MSD IECE Hearing Impairment VI Dose Communication Disorders Current Certification Program (applying for funding in)* LBD MSD IECE Hearing Impairment VI Dose Communication Disorders University* Have you previously received Traineeship Program funding?* No Yes Semester* Year* Course and Fund Request Information HiddenRequesting Funds for Academic Year* HiddenRequesting Funds for the following semester* Spring Summer Fall COURSES REQUESTED FOR THIS SEMESTER: Traineeship funds are available only for classes leading to certification in special education/IECE. You can add multiple courses by clicking on the plus sign at the end of each line item.Courses Requests*Course Number and Course Title must match how it is listed your curriculum. Example: SED500 Intro. to Disabilities.Course NumberCredit HoursCourse TitleStart and End DatesIs this an on-line course? Add RemoveEDUCATIONDegree(s) Earned beginning with B.A. or B.S.*You can multiple rows by clicking the plus sign at the end of each itemDegreeUniversityMajor Add RemoveRequired Documents that must be enclosed with this application: A copy of your curriculum contract or program of study plan, SIGNED by your University Advisor. A copy of your current teaching certificate. REQUIRED DOCUMENTSSigned Curriculum Contract or Program of study plan*Accepted file types: pdf, jpg, doc, docx, Max. file size: 32 MB.A copy of your current teaching certificate*Accepted file types: pdf, jpg, doc, docx, Max. file size: 32 MB.Principal Name* First Last Principal Email* Applicant Signature*Once your Principal verifies your information, you will receive an automated email.My signature indicates: That all of the information provided is accurate and that I am a U.S. citizen or permanent resident of the U.S. That I am NOT a recipient of any other traineeship, stipend, scholarship, fellowship, or grant for tuition for the courses applied for funding under the Traineeship Program. That the tuition for the courses I am applying for is not covered by any other source/financial aid. That upon completion of the Traineeship/certification program, I will continue to teach in Kentucky in the position for which I was funded for the number of semesters that I received funding. Grades must be submitted by the due date listed on the kytraineeship.org website. Notify the Traineeship in writing (email) immediately if you have dropped a funded course. Notify us in writing (email) if you would like to change a class for which you have already applied. The change must be approved for funding. Traineeship must receive a copy of your current certificate (Emergency, Probationary, or Temporary Provisional) in a timely manner. Applicant Signature* Reset signature Signature locked. Reset to sign again
