EIU MSED On-Campus OR Off-Campus Cohort - Interest Form

Please complete this form if you are interested in possibly completing your Master's in Education/Teacher Leader (and/or the Principal Endorsement) Program.

THIS IS NOT an official admission request form (please visit www.eiu.edu/myeiu to apply).

* - Required fields

MSED Program (choose one): *

MSED Program (choose one): Option #1 - Teacher Leader ... 33-hrs Option #2 - Principal ... 33-hrs Option #3 - Teacher Leader AND Principal ... 42-hrs Principal (PEP) only - non-degree Not sure -- please tell me more
Cohort: *

If your cohort location isn't available, please contact the Educational Leadership Department for more information about the possibility of new cohorts starting in your location. Phone: 217-581-2919 or E-mail: edadmin@eiu.edu
When do you plan to begin taking MSED courses? (SEM/YR; ex: Spring/2024) *
Name Name * First Last
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Cell Phone Cell Phone * - ### - ### ####
Work Phone Work Phone - ### - ### ####
Home Email *
Work Email *
School & district currently employed *
Position(s) held *
Years of teaching experience *
Locations of teaching experience *
Years of administrative experience (if applicable)
Locations of administrative experience
Do you currently work in a public schools district? *

Do you currently work in a public schools district? Yes No
Career goal in 5 years
Career goal in 10 years
Do you plan on becoming a public school administrator?

Do you plan on becoming a public school administrator? Yes No
If Yes,

If Yes, Within the next year Within the next 3 years Uncertain
Are there any special considerations we should be aware of in regard to your admission to our program? *