2025-2026 TEAM Model Clinical Residency Program Application

Question Title

* 1. Last Name

Question Title

* 2. First Name

Question Title

* 3. Middle Name

Question Title

* 4. NOTE: Comment here if you are referred to by your middle name or a double name.

Question Title

* 5. Tech Email (ex. avessel@email.latech.edu)

Question Title

* 6. Preferred Personal Email

Question Title

* 7. Phone Number (000-000-0000)

Question Title

* 8. Certification Area

Question Title

* 9. Campus Wide Student ID (000-00-000)

Question Title

* 10. Social Security Number (NOTE: write just like this with dashes 000-00-0000. We must have for residency teaching certificate.)

Question Title

* 11. Ethnicity

Question Title

* 12. Date of Birth (ex. 06/03/1999)

Question Title

* 13. Permanent Mailing Address (Street Name or Box Number)

Question Title

* 14. City

Question Title

* 15. State (ex. LA)

Question Title

* 16. Zip Code

Question Title

* 17. These are our current partner districts. Check all districts that you are interested in learning more about at the upcoming mid-year recruitment event.

LA Tech: A. E. Phillips Laboratory School

Bienville Parish Schools, Arcadia, LA

Bossier Parish Schools, Bossier/Benton/Haughton, LA

Caddo Parish Schools, Shreveport, LA

Claiborne Parish Schools, Homer/Haynesville/Summerfield, LA

DeSoto Parish Schools, Mansfield, LA

Grant Parish Schools, Colfax, LA

Jackson Parish Schools, Quitman, LA

Lincoln Parish Schools, Ruston, LA

Monroe City Schools, Monroe, LA

Natchitoches Parish Schools, Natchitoches, LA

Ouachita Parish Schools, Calhoun/West Monroe/Sterlington, LA

Rapides Parish Schools, Pineville/Alexandria/Tioga, LA

Richland Parish Schools, Rayville/Start/Mangum, LA

Webster Parish Schools, Minden/Sibley, LA

West Feliciana Parish Schools, St. Francisville, LA

Winn Parish Schools, Winnfield, LA

If you are from another district and have any interest in returning home, you may list that school district here. NOTE: There are no guarantees there will be new district partners, but we are open to your areas of interest.

Question Title

* 18. List all K-12 schools attended (ex. Weston High School - Jackson Parish) If a secondary major, you will not be placed at the high school you attended.

Question Title

* 19. DISCLOSURE STATEMENT: List any relatives that are current or former employees of the districts of interest. If it is an immediate relative (mom or dad), list all schools where they have worked. We must secure any special permissions needed. Include name, job title, and relationship to resident.

Question Title

* 20. Are you currently accepted into the Teaching Program?

Yes

I am currently applying.

Question Title

* 21. Have you passed your Praxis II Exam? Send scores to STATE OF LOUISIANA and LOUISIANA TECH UNIVERSITY!

If no, you should take the content exam(s) for the first time no later than Thanksgiving 2024! Let's get all scores by Christmas. Use spring only for retaking an exam if needed. Take every 28 days until you pass.
(NOTE: All certification exams should be taken by April and passed with Tech receiving official scores by June 1 in order to be fully accepted to the TEAM Model Clinical Residency Program.) (All PK-3/1-5 residents must pass the new ELA SOR - science of reading exam - 7000 series. Other exams can be 5000 level as they are the same as the 7000 test - just new number.)

Yes

I am waiting on my scores.

I have registered to take the exam(s). List test with registration date here:

Question Title

* 22. Have you passed your PLT exam? Send scores to STATE OF LOUISIANA and LOUISIANA TECH UNIVERSITY!

If no, you should take the content exam(s) for the first time no later than Thanksgiving 2024! Let's get all scores by Christmas. Use spring only for retaking an exam if needed. Take every 28 days until you pass.

(NOTE: All certification exams should be taken by April and passed with Tech receiving official scores by June 1 in order to be fully accepted to the TEAM Model Clinical Residency Program.)

Yes

I am waiting on my scores.

I have registered to take the exam. List test with registration date here:

Question Title

* 23. I UNDERSTAND THE INFORMATION LISTED BELOW:

1. I must be admitted to the Tech Teaching Program.
2. ALL required PRAXIS II and PLT scores must be sent to the State of Louisiana AND Louisiana Tech University. Make certain you mark those when registering.
3. I will follow the school district calendar as a resident so I will start the residency in August before fall quarter begins.

CRRC PRAXIS RESOURCES:
1. FREE Praxis Study guides for check out (Tuesday, Wednesday, Thursday between 9 a.m. - 3 p.m. or email to arrange pick up).
2. 240 Tutoring is a simulated online study tool. Join from latechcrrc.org page.

RESIDENCY COSTS:
Residency Certificate: no cost (When: May 2024)
Liability Insurance through APEL membership: approx. $20 (When: June/July 2024)
SWIVL membership: approx. $85 (When: August 2024)
Background Check: most are provided by your districts

TEAM MODEL CLINICAL RESIDENCY NEXT STEPS (TIMELINE):

NOVEMBER 2024
- Submit online Residency Application to the CRRC.

DECEMBER 2024
- RSVP to the CRRC Mid-Year Recruitment Event - held Friday, January 17, 2025, at the Davison Athletic Complex.

JANUARY 2025
-Participate in Mid-Year Recruitment
-Participate in CRRC Residency Interview Process

FEBRUARY/MARCH 2025
- Submit Residency District Requests.
- Check Tech email daily for communication from the CRRC.
- Update Mrs. Birch at crrc@latech.edu when you have evidence of Praxis registration or passing scores. Tech receives official passing scores approximately 2 weeks later. If you do not pass an exam, also reach out so we can provide additional resources and provide support in selecting next test date.

APRIL 2025
- Those with passing official Praxis scores will be able to register for residency during advising for fall quarter in April/May.
- Attend April TEAM Model Workshop - Date TBA.

MAY 2025
- Submission of Residency Certificate application. CRRC will submit to the Louisiana State Department of Education.

JUNE 2025
- Louisiana Tech should receive all official passing scores for Praxis II and PLT no later than June 1. Admission to residency, clinical placements, and registration for fall quarter residency class will only be finalized for those meeting this requirement.

Yes

Question Title

* 24. Attach a Preferred Photo (headshot - to be used in upcoming district/school announcements)

PNG, JPG, JPEG file types only.

Choose File

Question Title

* 25. Additional Comments/Questions.

Question Title

* 26. I understand that I will not be allowed during spring advising to register for residency, be placed for residency, or begin residency until all requirements are met for admission to the TEAM Model Clinical Residency Program. If scores are not received in time to submit state required residency application, residency program will be deferred to following academic year.

Date / Time

Date

Time

AM/PM

Question Title

* 27. I certify that the information submitted above is true and accurate. On this date, I submit my 2025-2026 TEAM Model Clinical Residency Application.

Date / Time

Date