University of Wisconsin System
School Library Education Consortium
Distance Program Application Form
 
Name
Mailing Address
City
State
Zip
Home Phone
E-mail
Place of Employment
Position
Work Phone
 
Indicate the licensure program you wish to enroll in:
902 Initial - Library Media Specialist (formerly 901)
902 Professional - Professional Library Media Specialist (formerly 902)
Indicate the semester you wish to begin the program:
Fall
Spring
Summer

Year

 
Indicate ONE campus you will use as your home institution:
UW-Eau Claire
UW-Madison
UW-Oshkosh
UW-Superior
UW-Whitewater
 
Indicate your anticipated enrollment status:
Master's Degree Candidate
Special Student (Graduate Level) - Licensure Only
Exceptional Circumstance (subject to class space availability)
If you checked exceptional circumstance, please explain (e.g., wish to take only one course, etc.):
Do you currently hold a 901 (Library Media Specialist) license?
Yes
No
 
Indicate areas of your current teaching license:
 
Explain your current employment situation and your reasons for applying to the distance program; indicate if you currently hold an emergency license to work in a school library:
 
Check any of the courses below that you have taken within the past seven years (at either the undergraduate or graduate level):

902-Initial Courses
Reference
Cataloging
Collection Development
Instructional Technology
Information Literacy
Administration
Children's Literature
Young Adult Literature

902-Professional Courses
Curriculum Development and Integration
Trends in K-12 Literature
Information Systems
Virtual Libraries
Advanced Design
Administration of Library and Technology Programs

 
Thank you for your application. You will be contacted via e-mail about your status. Specific course registration information will be sent to eligible students upon admission to the program.

Please submit electronically OR print and mail to:
Carrie Lencho
Graduate Studies and Continuing Education
UW-Whitewater
800 W. Main Street
Whitewater, WI 53190

(800) 621-5376
lenchoc@uww.edu

Last update: 04/26/05

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