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Teacher Apprenticeship Pathway Application

Teacher Apprenticeship Pathway Application

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Use this service to submit a Teacher Apprenticeship Pathway Application.

Questions should be directed to Dr. Kathryn Blaha with the South Dakota Department of Education (DOE) at (605) 773-3134 or DOEApprenticeship@state.sd.us.

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Applicant Information

First Name

Preferred First Name

Middle Name

Last Name

Previous Last Name (if applicable)

Work Phone Number

Cell Phone Number

Work Email Address

Personal Email Address

Home Address

Street Address

Mailing Address (if different than above)

Apartment/Suite #

City

State

Zip Code

Emergency Contact

Contact's First Name

Contact's Last Name

Emergency Contact's Relationship to You

Contact's Phone Number

Additional Information

This information allows the South Dakota Board of Regents to complete your profile in its Student Information System. It will not be provided to the selection committee.

Sex

Sex Female Male Prefer Not to Identify

Date of Birth (mm/dd/yyyy)

Social Security Number

Is your ethnicity Hispanic or Latino?

Is your ethnicity Hispanic or Latino? Yes No

What is your race? (Select all that apply)

Are you a U.S. Citizen?

Are you a U.S. Citizen? Yes No

Have you lived in South Dakota for the past 12 months?

Have you lived in South Dakota for the past 12 months? Yes No

Employment Information (Required)

District of Employment:

Superintendent First Name

Superintendent Last Name

Superintendent Email

What is your current position?

Identify the grade level(s) associated with your assignment

How long have you been employed in your current position?

Prior experience in other school districts? Please list below, including the length of time in each position.

Grade level open to teach

If secondary, specify subject area:

English Language Arts

Mathematics

Science

Social Studies

What do you hope to do after earning your teaching degree?

Education Background (Preference will be given to those with post-secondary credits)

Have you earned credits or a diploma/degree at any higher education or post-secondary institute?

Have you earned credits or a diploma/degree at any higher education or post-secondary institute? Yes No

If so, attach a transcript (Unofficial is acceptable)

College/University/Technical College

Location

Start Date (mm/dd/yyyy)

End Date (mm/dd/yyyy)

Did you graduate

Did you graduate Yes No

Credits Earned

If yes, diploma/degree:

Degree Type

Character and Fitness

Answer the following questions with either a yes or no. If there is a yes answer, please explain on a separate sheet of paper, and attach to your application. Terms used in this section have the following definitions:
• “Criminal offense,” includes any crime (all Class I or II misdemeanors or felonies) which are not a minor traffic offense.
• “Minor traffic offense” includes any non-moving violations occurring in a vehicle.
• “Charged” includes any arrest or filing of charges, even if the charges were dismissed, or reduces by a plea agreement in any city, county, state, tribal, or federal court.
• “Conviction,” includes any finding of guilt by a judge or jury, any admission of guilt or plea of guilty, or any plea of no contest /nolo contendre, even if the sentence was stayed, suspended, pardoned, expunged, or you received a suspended imposition of sentence or deferred judgment.
• “Adverse action,” includes a letter of warning, reprimand, denial, non-renewal, suspension, revocation, voluntary surrender, or cancellation of any license in any state, the District of Columbia, country, or territory.
• “License,” includes any credential, certificate, or license.

1. Have you ever been arrested or charged with any criminal offense?

1. Have you ever been arrested or charged with any criminal offense? Yes No

• If yes, explain briefly by listing the offense, the date/year, and location it occurred. Note: You may be asked for court documents relating to the criminal matter/offense.

2. Have you ever been convicted or pleaded guilty to any criminal offense?

2. Have you ever been convicted or pleaded guilty to any criminal offense? Yes No

• Explain the crime for which you were convicted, dates of your conviction or plea of guilty, dates you were sentenced, sentence imposed. If you have been discharged from probation, include information on your discharge from probation. If currently on probation, officer name and number.

Explain briefly by indicating the crime for which you were convicted, the dates of your conviction or plea of guilty, and the dates you were sentenced, and the sentence imposed. If you have been discharged from probation, include information regarding your discharge from probation. If you are currently on probation, provide the name and number of your probation officer. Note: You may be asked to provide all court documents relating to the criminal offense.

3. Have you ever been investigated in connection with a charge of child abuse or neglect?

3. Have you ever been investigated in connection with a charge of child abuse or neglect? Yes No

• If yes, explain briefly. Note: You may be asked to provide all court documents relating to the charge.

4. Have you ever been in arrears or failed to pay child support in this state or elsewhere?

4. Have you ever been in arrears or failed to pay child support in this state or elsewhere? Yes No

5. Have you ever had any credential, certificate or license authorizing school teaching or educational service suspended, revoked, voided, cancelled, denied, rescinded, rejected for cause and/or otherwise taken away in SD or in any other state, commonwealth, territory, or possession of the U.S.?

Have you ever had any credential, certificate or license authorizing school teaching or educational service suspended, revoked, voided, cancelled, denied, rescinded, rejected for cause and/or otherwise taken away in South Dakota or in any other state, commonwealth, territory, or possession of the United States or elsewhere?

• If yes, explain briefly. Note: You may be asked to provide all documents explaining the action, location(s), date(s), and agency involved.

6. Is there any type of adverse action pending against any credential, license, or certificate that you now hold or have ever held that authorizes school teaching or educational service?

6. Is there any type of adverse action pending against any credential, license, or certificate that you now hold or have ever held that authorizes school teaching or educational service? Yes No

• If yes, explain briefly including the action or charges, location(s), date(s) and agency involved.

7. Have you ever left employment or been terminated to avoid disciplinary action?

7. Have you ever left employment or been terminated to avoid disciplinary action? Yes No

• If yes, explain briefly including the employer, the dates/timeline of the action and location/state involved.

8. Have you ever held a license, certificate, or credential, other than as a teacher or administrator, which has been revoked, cancelled, rescinded, suspended or taken away in South Dakota or elsewhere?

• If yes, explain briefly including the name of the state in which the certificate, credential or license held and the present status of each certificate, credential or license.

9. Is there any other information not disclosed by your answers concerning your background, history, experience, education or activities which may have some bearing on your character, moral fitness or eligibility to teach or hold an administrative position in South Dakota?

Is there any other information not disclosed by your answers concerning your background, history, experience, education or activities which may have some bearing on your character, moral fitness or eligibility to teach or hold an administrative position in South Dakota and which should be placed at the disposal or brought to the attention of the South Dakota Department of Education?

Required Documents and Submission Materials

Please upload your transcript(s) and any other documents required.

File attachments associated with the ticket.

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Applicant Commitment and Memorandum of Understanding

You must initial each of the following statements to indicate agreement and understanding:

I understand and agree that, upon successful selection into the Teacher Apprenticeship Pathway, I will be responsible for $1,000 per year to assist with tuition cost.