Southwestern Union Conference Teachers
SSL Certificate
  Complete the form and click next at end of form (no application fee required)
Double check all spelling and be as complete as possible.   

This summer on-campus program is only for Southwestern Union Teachers with a bachelors degree.

Personal Data
Your Full Legal Name:
  Last Name (Family Name or Surname) First Name Middle Name Suffix
  First Name you prefer to be called Previous Last Name(s) Title

Date of Birth:      Gender:   Male     Female
  Month Day Year  

U.S. Social Security Number:   
     (This is a secure server, your personal information will be safe)

E-Mail Address:      FAX number:   
 (If available)  (If available)

Home Address:
 Number and Street (physical address) City State Zip Code Country (if not USA)

Phone Numbers:  
   Home Phone Cell Phone (if available) Work Phone

Mailing Address: (if different from Home Address)
 P.O. Box or alternative Number and Street City State Zip Code

Your Religion:  

Nation of Citizenship:           Nation of Birth:  

 Check which one applies. Your response is voluntary and will be used in a nondiscriminatory manner consistent with applicable civil rights laws
  Black or African American Native American or Alaskan Native Asian or Pacific Islander
  Hispanic White/Caucasian Other/Unknown

Southwestern Union Conference school where you are employed:  

Academic Information
When do you wish to start your attendance?   

Have you applied to Southwestern Adventist University before?     Yes     No
Have you attended Southwestern Adventist University before?     Yes     No

Which type of enrollment do you wish?
  To complete teacher certification — elementary education
  To complete teacher certification — secondary education

The primary reason for taking this work is to:
  Qualify for initial certification
  Renew a previous certification
  Maintain current certification

Which course(s) are you interested in taking?   (Check all that apply)
   EDUC 555Educational Assessment   3 credits
   EDAD 505Management of School Resources   3 credits
   EDRE 515Advanced Children's Literature   3 credits
   EDRE 520Language: Grammar and History   3 credits

From which College or University did you obtain your bachelors degree?
 School City State or Country Degree earned Date of Graduation

Please ask the College or University to send an official transcript to:

Admissions Office
Southwestern Adventist University
Keene, TX 76059

An acceptance cannot be processed until an official transcript is received by Southwestern Adventist University.

Student Pledge

By electronically submitting this application, I certify that the above statements are correct and complete.   I understand that incomplete or false information may make me ineligible for admission to or continuation at Southwestern Adventist University.