Polk State College Educator Preparation Institute Program Education Plan Entrance Interview



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Polk State College Educator Preparation Institute

Program Education Plan Entrance Interview

Each teacher candidate is required to submit this document prior to enrolling in the Educator Preparation

Institute (EPI). After completion, this document, may be emailed as an attachment to Sharron Davis

(sdavis@polk.edu), faxed to 863.298.6814 or delivered in person to the EPI Office on the Winter Haven Campus (WST128). The applicant is contacted regarding enrollment approval after this document is reviewed internally. Each applicant must hold a minimum of a bachelor’s degree in a field outside of Education to be eligible for acceptance. Questions related to this document can be directed to Sharron Davis, Senior Program Specialist (sdavis@polk.edu).

Official transcripts from all colleges and universities attended must be received by the Polk State Registrar’s Office before the individual may actually begin the EPI Program. Because the EPI operates using a cohort model, it is important to submit all transcripts to the Registrar before the desired cohort begins coursework. If transcripts are not received in time, the individual must wait for the next cohort to begin.

Admission Requirements:


  1. Submission of an application to the Florida Department of Education (FLDOE) for a Professional Teaching Certificate. The current application fee is $75 per subject area. The applicant receives a Statement of Eligibility (SOE) four to six weeks after the application is submitted.

  2. Submission of a copy of the Statement of Eligibility (SOE) that authorizes eligibility for a temporary teaching certificate. This must be received at least a week before the first class begins.

  3. Completion of the Florida Teacher Certification Exam (FTCE) within a chosen subject area and submission of the report showing the passing score. The current testing fee is $200 per subject area.

  4. Submission of the completed Entrance Interview Questionnaire to Sharron Davis at sdavis@polk.edu.

  5. Completion of a Polk State College application.

  6. Completion of the Polk State New Student Orientation (online).

  7. Submission of all official college transcripts to the Polk State Registrar’s Office.

  8. Evidence of a 2.5 GPA (minimum) on the transcript in the related field of study.

Before enrolling in the EPI 0020 Professional Foundations course or EPI 0940 Professional Foundations: Field Experience course, the following requirements must be met. The teacher candidate is not able to continue the program until these requirements are met:

  1. Obtain a passing score on the Florida Teacher Certification Exam—General Knowledge Test. The current fee is $130 for any combination of the four subtests.

  2. Cleared Level 2 background check from the district where teacher candidate plans to complete his or her field experience. The current fee for a background check in the Polk School District is $55.25 good for 2 years in Polk County, or $78.60 valid for any County in the State of Florida.

Before Program Completion, the teacher candidate must pass the Professional Ed Test.

1. Completion of the (FTCE) Professional Ed Test. The current fee is $150.



The Educator Preparation Institute Program Education Plan Entrance Interview

Date:_______ Name:_________________________ E-mail:_____________________

Address:_______________________________________________________________

Phone number:_______________ Gender:___________________________

Planned start date:________________ with cohort: ____________________________

Official transcripts requested on: (date) _________



Degree Earned

Subject Area

College Attended

Cumulative GPA

(Required Information)



Associate’s degree









Bachelor’s Degree









Master’s Degree









Specialist’s Degree or Ph.D.









Preferred method of contact: (Please select one.) E-mail ____ Phone____

Currently teaching? Circle: Yes/No

Name of school: _______________________

Age group of interest or age group the individual is currently teaching: (Check one)

Elementary School____ Middle School___ High School___

Intended instructional subject: __________________

If an individual has a temporary teaching certificate when entering the EPI Program and it expires before program completion, he or she is required to apply to the Florida Department of Education for temp to pro letto documentation. A copy of the letter received must be submitted to the EPI Office before continuing any more classes.

If the individual’s temporary certificate expired less than one year before enrollment and he or she is applying for entry to the EPI Program, the individual must also apply for the temp to pro letto documentation before starting the EPI Program.

The enrolling candidate must place a check next to all items below (from choice one and two) that pertain to his or her situation and e-mail copies of all documents to Sharron Davis (sdavis@polk.edu).


  1. Each program candidate must obtain a Florida Department of Education Statement of Status of Eligibility.

___I have a Statement of Eligibility, and the FLDOE number is ______________.


___I have a receipt of application for my Statement of Eligibility.


___I have applied for my Statement of Eligibility.

___I have not applied for my Statement of Eligibility, but I understand I must submit this within 30 days and provide proof of having applied for it to the EPI Office a week before my first class or I will be denied entry to the program.

___I have a temporary teaching certificate that is valid for at least another year. The expiration date is _______, and the FLDOE number is_______________.

___I have a temporary teaching certificate that expires in the next year. The date my temporary certificate expires is ________, and the FLDOE number is ______________.



  1. A report showing a passing score on the Florida Teacher Certification Exam—Subject Area Exam is required for entry to the EPI Program.

__Subject Area Exam passed on ____________.Required to Entry to the EPI Program __General Knowledge (check those passed): __Math __Reading __Essay __English __Professional Education Exam passed on ___________.

Each candidate must read and initial the statement below indicating an understanding of the requirements regarding certification exams:

I understand that I am to submit proof of passing the FTCE—General Knowledge Exam with a report of the results by the end of the fifth course of the program. _______(initial)

Where did the candidate hear about Polk State’s Educator Preparation Institute?

__Another EPI student __A teacher __An advisor __Presentation

__School district __Brochure __Website __News article

__Other __________________________________

Are there any circumstances that might prevent the candidate from passing the background screening? Circle:

Yes/No

If yes, please explain: ____________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Describe the motivating factors, inspiration, or experiences that led the candidate to pursue teaching as a profession: ______________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Please describe any qualities or skills possessed that would be beneficial in the quest to become a highly qualified teacher: _________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Please describe and relate any prior teaching or training experiences with students, children, or

adults:____________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________

Technology is an integral part of education; any background or skills with technology are an asset.

Does the candidate own an Internet-connected computer? Circle: Yes/No

Describe any relevant software and computer skills and proficiencies: _____________

__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________

Describe fluency with PowerPoint, including the use of graphics, transitions, and background designs. (Note: PowerPoint is used for the first EPI course; those who are unfamiliar should practice skills before the first class.)__________________________

_____________________________________________________________________

_________________________________________________________________________________________ _________________________________________________________________________________________ _____________________________

By submitting this application, the candidate acknowledges that he or she has received a four-year bachelor’s degree from an accredited institution (candidates may inquire about accreditation through the Department of Education Certification Office at 1.800.445.6739). The candidate acknowledges that there are no guarantees for acceptance into the Polk State Educator Preparation Institute.

Full acceptance means that the candidate must provide a passing FTCE—Subject Area Exam score report, provide all official transcripts to the Polk State Registrar’s Office, complete the New Student Orientation, and complete fingerprinting and background check responsibilities with the school district by the fourth month of enrollment in the program. By the end of the fifth class, the candidate must pass the FTCE—General Exam and submit the score report to the EPI Office. Failure to do so precludes the candidate from participating in any field experiences and the last two program courses.

By submitting this application for the EPI Program, the candidate authorizes Polk State College personnel to confirm program enrollment and/or completion status to public and private school districts and/or the Florida Department of Education. Submission of this application confirms that the candidate has reviewed this application with full understanding of all requirements, and affirms that all of the information provided is true, accurate, and complete.

Program applicant’s signature: ____________________________

__________DO NOT WRITE BELOW THIS LINE OFFICIAL USE ONLY__________

Applicant [___has / ___has not] been provisionally accepted/accepted into the Educator Preparation Institute at Polk State College. Listed below is the cohort group and schedule for classes that begin in ____________ term.



Start date: ________________ Cohort name: ___________________________


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