JCPS Teacher Residency Program

Please confirm the information below to move forward with your Bellarmine admission.

Biographical Information

First Name

Preferred First Name (if different than your first name listed above)

Middle Name

Last Name

Other Last Names

Email Address

Mailing Address

Country

Street

City

Region

Postal Code

Birthdate

Sex

Academic History

Please list all colleges/universities attend.

DeleteSchool _ID_
School History
School Name School 1 Ceeb Code (hidden): School Level of Study School Start Date School Start Date School End Date School End Date School Degree Received School Degree Received Date School Degree Received Date

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Program Information

Choose program

Would you like to add Special Education to your program of study?

Would you like to pursue dual certification? If so, please choose your second program.

Entry term

Additional Information

Primary Citizenship

Are you a permanent resident of the United States?

Yes

Current Visa Type (If unknown select "other")

The Social Security Number is requested for the purpose of record verification and mandatory state and federal reporting requirements for which the institution is responsible. It is also required of any student applying for financial aid and/or requiring 1098T for federal tax purposes. Your social security number will not be used as your primary student ID.

Social Security Number

Bellarmine University admits qualified students of any age, gender, gender identity, sexual orientation, race, disability, color, religion, and national or ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of age, gender, gender identity, sexual orientation, race, disability, color, religion, or national or ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic and other school administered programs. Bellarmine University will not tolerate any form of sexual misconduct, which includes, but is not limited to, sexual harassment, non-consensual sexual contact, non-consensual sexual intercourse, sexual exploitation, rape or retaliation arising out of any of the above acts, as more fully defined in the Bellarmine Sexual Discrimination and Misconduct Policy in the Student and Employee Handbooks. Bellarmine University is an equal opportunity employer.

The electronic signature consists simply of your name, typed by you on your keyboard. The signature is your confirmation that the application you have filled out is your own work and the information is factually true. Once you type in your name, this will count as your electronic signature.

Signature

JCPS Teacher Residency Program

Main Campus

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