UA CALT Application Form Personal Info.Please fill out this form completely; all information is required.Name First Last Date MM slash DD slash YYYY Address Street Address Apartment/Unit # City State / Province / Region ZIP / Postal Code PhoneEmail Are you a certified teacher? Yes No Current Position (School/Grade/Other)Include the school district and name of school.Current Position (School/Grade/Other)Include the school district and name of school.Why do you want to participate in the UA CALT Dyslexia Therapist Program?Do you live in Alabama? Yes No If yes, do you want to be considered for the Scottish Rite Foundation Scholarship? Yes No I have a bachelor's degree and have attached an unofficial transcript. Yes No I have a master's degree and have attached an unofficial transcript. Yes No Additional Info.Space in the program is limited. Please describe the following:What makes you a good candidate for the UA CALT Dyslexia Therapist Program?Do you have a plan for completing 700 teaching hours? Please explain.Disclaimer & SignatureAgreement I understand that: 1) UA CALT is a two-year program of coursework, 2) Take Flight® is the curriculum currently being used, and 3) that a master’s degree, 700 required hours of instruction and the CALT exam must be completed within 5 YEARS of beginning the program.SignaturePlease re-enter your first and last name.Date MM slash DD slash YYYY Select today’s date.Please upload your unofficial transcript here:Max. file size: 2 MB. CAPTCHA
