Microcredential Application

Academic Information

Please choose which Microcredential you are interested in:

Science of Reading Fundamentals

By submission of this form, I authorize SUNY New Paltz to register me for EDI699, Science of Reading Fundamentals.
I acknowledge that registering for classes will generate charges and these charges will be reflected on an invoice sent to my.newpaltz.edu account.

Yes, I agree

Do you have a State-issued Teaching Certificate / Licensure?

Yes, I hold an active initial NYS teaching certificate

Yes, I hold an active professional NYS teaching certificate

No, I do not hold an active NYS teaching certificate at either the initial or professional level

Please note: You will be required to upload a copy for our review after you submit the application.

Requested Start Date

*Please note: Additional dates for Spring 2024 registration will be released in September 2023.

Academic Background

What State do you teach in?

Which school district do you currently teach in?

Are you full or part time employee?

Part-Time

Full-Time

Which teaching/administrative level best describes you?

If "Other", please explain:

Have you previously applied to SUNY New Paltz?

Yes, I applied and was accepted as a matriculated student

Yes, I applied and was NOT accepted as a matriculated student

No, I have not previously applied to SUNY New Paltz

Have you been dismissed from a college for disciplinary reasons or convicted of a felony?

Yes

No

Personal Information

First Name

Chosen/Preferred First Name

Middle Name

Last Name

Former Last Name

Birthdate

Email Address

Primary Phone Number

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Mailing Address

Country

Street

City

Region

Postal Code

Demographic Information

Are you Hispanic/Latinx?

Yes

No

Please indicate your race (check all that apply):

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Please indicate your legal sex:

Female

Male

Other

Please indicate your gender identity:

Female

Male

Nonbinary

No

Please indicate if you are one of the following:

Residency

Are you a citizen or permanent resident of the U.S.?

Yes

No

Have you been a permanent resident of New York State for the last twelve months or more?

Yes

No

Current county of residence

My country of citizenship is:

The visa type I have or am seeking:

Emergency Contact Information

First Name

Last Name

Email Address

Phone Number

Country

Street

City

Region

Postal Code

Certification

I certify that the information given in this application for admission is complete and correct. I understand that any falsification or omission of data may result in the denial of admission or disciplinary action.

Signature