Personalized Learning Application

If you see this don't fill out this input box.

*Today's Date

*Full Name

*KSU #

*PSC Login Account Number

(6 digit number that appears on your Georgia certificate and is used on correspondence to and from the PSC. If you do not have a PSC number and are therefore not a Georgia certified teacher, please type in XXXXXX in place of the 6 digit number.)

*Daytime Phone Number

*Email Address

Home Address

I plan to take the

Personalized Learning Endorsement program.Personalized Learning Certificate program.

My current home department is

Please Select School of Instructional Technology & Innovation Elementary & Early Childhood Education Secondary & Middle Grades Education Educational Leadership Inclusive Education Not currently enrolled in a BCOE program

*Georgia Clear / Renewable Teaching Certificate

YesNo

I have access/ permission to teach a group of K12 students in your certification field during the fall and spring semester for ITEC 7602 and ITEC 7603

YesNo

Teaching Certification Areas/Grade Levels

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