Please fill out this form if you wish to transfer form an existing program to the Alternate Route Program First name Last name Date of birth Gender - Select -FemaleMaleOtherPrefer not to answer Race - None -AsianBlackWhiteHawaiian/Pacific IslanderHispanicNative AmericanTwo+ RacesOther Phone # Primary email Secondary email Date of Last Course Taken Previous Provider Affiliation - Select -Rutgers UniversityEssex County Provisional ProgramKean UniversityMonmouth UniversityMorris Union Jointure CommissionNew Jersey Center for Teaching and LearningNew Jersey CIty UniversityRelay Graduate School of EducationRowan UniversitySt. Peter's University OtherNot Applicable List of Phases/Stages Completed 50-Hour Preservice Phase 1 Phase 2 Phase 3 Endorsement Sought - Select -1001 - Elementary School Teacher in Grades K - 61005 - Teacher of Supplemental Instruction in Reading and Mathematics K-81102 - Elementary School Teacher with Mathematics Specialization: in Grades 5 - 81103 - Elementary School with Subject Matter Specialization: Science in Grades 5 - 8 1104 - Elementary School with Subject Matter Specialization: Social Studies in Grades 5 - 81106 - Elementary School with Subject Matter Specialization: Language Arts/Literacy Specialization in Grades 5 - 8 1110 - Middle School with Subject matter Specialization: World Language/French in Grades 5 - 81200 - Teacher of Art 1300 - Teacher of Comprehensive Business1301 - Business: Accounting1302 - Business: Finance/Economics/Law1303 - Business: Keyboarding/Data Entry1410 - Teacher of English1451 - Teacher of Theater1475 - English as a Second Language1505 - American Sign Language1510 - Teacher of French1520 - Teacher of German1530 - Teacher of Italian1540 - Teacher of Latin1550 - Teacher of Spanish1560 - Teacher of Russian1570 - Teacher of Greek1572 - Teacher of Chinese 1573 - Teacher of Japanese1574 - Teacher of Portuguese1578 - Teacher of Hebrew1579 - Teacher of Korean1580 - Teacher of Arabic1590 - Teacher of Other Foreign Languages1605 - Teacher of Health and Physical Education 1630 - Teacher of Physical Education1635 - Teacher of Dance1810 - Teacher of Technology Education 1900 - Teacher of Mathematics 2100 - Teacher of Music 2210 - Teacher of Biological Science2220 - Teacher of Earth Science2240 - Teacher of Physical Science2260 - Teacher of Physics2270 - Teacher of Chemistry2300 - Teacher of Social Studies2350 - Teacher of Psychology Second Endorsement Sought if applicable - None -1001 - Elementary School Teacher in Grades K - 61005 - Teacher of Supplemental Instruction in Reading and Mathematics K-81102 - Elementary School Teacher with Mathematics Specialization: in Grades 5 - 81103 - Elementary School with Subject Matter Specialization: Science in Grades 5 - 8 1104 - Elementary School with Subject Matter Specialization: Social Studies in Grades 5 - 81106 - Elementary School with Subject Matter Specialization: Language Arts/Literacy Specialization in Grades 5 - 8 1110 - Middle School with Subject matter Specialization: World Language/French in Grades 5 - 81200 - Teacher of Art 1300 - Teacher of Comprehensive Business1301 - Business: Accounting1302 - Business: Finance/Economics/Law1303 - Business: Keyboarding/Data Entry1410 - Teacher of English1451 - Teacher of Theater1475 - English as a Second Language1505 - American Sign Language1510 - Teacher of French1520 - Teacher of German1530 - Teacher of Italian1540 - Teacher of Latin1550 - Teacher of Spanish1560 - Teacher of Russian1570 - Teacher of Greek1572 - Teacher of Chinese 1573 - Teacher of Japanese1574 - Teacher of Portuguese1578 - Teacher of Hebrew1579 - Teacher of Korean1580 - Teacher of Arabic1590 - Teacher of Other Foreign Languages1605 - Teacher of Health and Physical Education 1630 - Teacher of Physical Education1635 - Teacher of Dance1810 - Teacher of Technology Education 1900 - Teacher of Mathematics 2100 - Teacher of Music 2210 - Teacher of Biological Science2220 - Teacher of Earth Science2240 - Teacher of Physical Science2260 - Teacher of Physics2270 - Teacher of Chemistry2300 - Teacher of Social Studies2350 - Teacher of Psychology NJDOE Tracking Number Reason for leaving Please indicate what assessment you used to meet the NJ Department of Education's Basic Skills Assessment Requirement (Require - Select -PraxisSATACTGRE Qualifying GPA Syllabus file One file only.10 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods. Report file One file only.10 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods. 24 hour certificate/vopc file One file only.10 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods. CE file One file only.100 MB limit.Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. If applicable, enter your Praxis II Subject Assessment Praxis II score Transcript One file only.100 MB limit.Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. Core/Basic skills scores One file only.100 MB limit.Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. Praxis II score file One file only.100 MB limit.Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. Payment Agreement - Select -Yes "Yes" you agree to the following: Please transfer me into the Rutgers Alternate Route Program. I understand that if I am accepted to the program, I will be charged a $25 program transfer fee. I also understand that I must complete the Program Transfer Course required of all candidates who transition to the Rutgers Alternate Route Program.
