Name: (Last, First, MI)							SSN:
Primary Address for WNMU mailings:							Phone:
(Street): (City):							(H)
(State): (Zip Code):							(W)
Catalog Authority:			Licensure #:	Admission Date:	Regular:			Provisional:
GRE Required: Y ___ N ___ Scores: Passed Date of GRE:
NMTA: BS: TC: CK:
Date Completed TEP Application:						GPA (last 64 hours):
CORE (9 HOURS)						Credit	Term			Grade
EDUC	500	Methods of Research				3
EDUC	506	History and Philosophy of Education				3
PSY	505	Psychology of Learning				3
TEACHING FIELD MAJOR (20-21 HOURS): __________________________
ELECTIVE (MUST BE APPROPRIATE TO DEGREE) (6-7 HOURS)
TOTAL HOURS						36
Exit Examination Passed:____________ Date:

APPROVED	Date:
MAT Graduate Candidate:
MAT Advisor:
SOE Dean:
Director of Graduate Division:
Date Filed in Registrar’s Office:

Note: All degree requirements must be completed within a seven-year period. Student must file an advisor-approved degree plan & application for degree audit with the Registrar’s Office by date published in current class schedule.