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I understand that pre-application materials and all supporting documents become the confidential property of the St. Thomas CUE and admissions office and cannot be returned to the applicant. I understand that program participants have an obligation to teach in a Minnesota School District upon completion of the CUE licensure program. Signature Date. Mail all application materials directly to Jeanne Mortinson CUE Program Director University of St. Thomas 1000 LaSalle Ave MOH 217 Minneapolis MN 55403 CUE Application Page 1 CUE APPLICATION Email jmmortinson stt1-962 and Counseling License area of interest Check one Special Education English as a Second Language Name Last First MI Former Birth Month/Day Home Address City Home Phone State Postal Code E-mail Please indicate your status U.S. Citizen Permanent U.S. Resident Cell Phone Are you legally authorized to work in the U.S. Yes No Country of Citizenship Employer Position Work Address Work Phone Preferred Phone Home Are you fluent in a language other than English Work Cell Yes Language No Do you have a valid or renewable educational license from any state If yes indicate state File No. Current Licensure Area PREVIOUS EDUCATION - Undergraduate and Graduate 1. College of Education Leadership and Counseling CUE PROGRAM APPLICATION Application Deadline is July 19 2013 Include the following materials o Pages 2 3 of this Application form o Letter of Interest- One page maximum o Current Resume Two pages maximum o Unofficial transcript showing college degree For an international transcript submit document reviewed by an accredited evaluation service to determine U*S* equivalency of the degree awarded and the institution awarding the degree. Institution Name Major Degree Sought Degree Received Country Years Attended I certify that the information I have provided on this application and all other materials is complete accurate and true to the best of my knowledge. I understand that pre-application materials and all supporting documents become the confidential property of the St* Thomas CUE and admissions office and cannot be returned to the applicant. I understand that program participants have an obligation to teach in a Minnesota School District upon completion of the CUE licensure program* Signature Date. Institution Name Major Degree Sought Degree Received Country Years Attended I certify that the information I have provided on this application and all other materials is complete accurate and true to the best of my knowledge. I understand that pre-application materials and all supporting documents become the confidential property of the St* Thomas CUE and admissions office and cannot be returned to the applicant.

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