University of Wisconsin System School Library Education Consortium Distance Program (UWSSLEC)

Electronic Application Form

Name Mailing Address City State Zip Code Home Phone Primary E-mail Secondary E-mail Employer 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:

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 902 - Initial (Library Media Specialist) license?

Yes

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 and emergency license to work in a school library.

Check any of the courses below that you have taken within the past seven years (at eitherthe 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

Instructional Theory and Technology Integration

Trends in K-12 Literature

Information Systems

Virtual Libraries

Advanced Design

Adminstration of Library and Technology Programs

If you have questions, please contact:

Carrie Lencho
Graduate Studies and Continuing Education
UW-Whitewater
800 W Main Street
Whitewater, WI 53190

(800) 621-5376
lenchoc@uww.edu

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