Benchmark I Application

School of Education

First Name:
Middle Initial:
Last Name:
Student ID:
Major:
Minor/Certification:
Gender:
Ethnicity:
Email Address:
Date of most recent PPST Attempt:	mm/dd/yy
Semester and Year of most recent Background Check:

By typing my name below, I certify that the information provided above is truthful and accurate to the best of my knowledge and that knowingly providing false information or omitting information may result in an ineligibility to interview for the Benchmark I Interview.
Type name here:
Date:	mm/dd/yy