2027-2028 TEAM Model Clinical Residency Program Application Survey

1.Last Name

2.First Name

3.Middle Name

4.NOTE: Comment here if you are referred to by your middle name or a double name.

5.Tech Email (ex. avessel@email.latech.edu)

6.Preferred Personal Email

7.Phone Number (000-000-0000)

8.Certification Area

9.Campus Wide Student ID (000-00-000)

10.Social Security Number (NOTE: write just like this with dashes 000-00-0000. We must have for residency teaching certificate.)

11.Ethnicity

12.Date of Birth (ex. 06/03/1999)

13.Permanent Mailing Address (Street Name or Box Number)

14.City

15.State (ex. LA)

16.Zip Code

18.List all K-12 schools attended (ex. Weston High School - Jackson Parish) If a secondary major, you will not be placed at the high school you attended.

19.DISCLOSURE STATEMENT: List any relatives that are current or former employees of the districts of interest. If it is an immediate relative (mom or dad), list all schools where they have worked. We must secure any special permissions needed. Include name, job title, and relationship to resident.

20.Are you currently accepted into the Teaching Program?

Yes

No

I am currently applying.

21.Have you passed your Praxis II Exam? You are required to send all test scores to STATE OF LOUISIANA and LOUISIANA TECH UNIVERSITY!

We recommend you get all tests taken by the end of January!! Use spring only for retaking an exam if needed. Take every 28 days until you pass.

(NOTE: All certification exams should be taken by April and passed with Tech receiving official scores by June 1 in order to be fully accepted to the TEAM Model Clinical Residency Program.) (All PK-3/1-5 residents must pass the new ELA SOR - science of reading exam - 7000 series. Other exams can be 5000 level as they are the same as the 7000 test - just new number.)

You will NOT be accepted to the residency program or be authorized to register for residency until passing scores are received.

Yes

I am waiting on my scores.

No

I have registered to take the exam(s). List test with registration date here:

22.Have you passed your PLT exam? You MUST send scores to STATE OF LOUISIANA and LOUISIANA TECH UNIVERSITY!

If no, you should take the content exam(s) for the first time no later than Thanksgiving 2025! Let's get all scores by Christmas. Use spring only for retaking an exam if needed. Take every 28 days until you pass.

(NOTE: All certification exams should be taken by April and passed with Tech receiving official scores by June 1 in order to be fully accepted to the TEAM Model Clinical Residency Program.)

You will NOT be accepted to the residency program or be authorized to register for residency until passing scores are received.

Yes

I am waiting on my scores.

No

I have registered to take the exam. List test with registration date here:

23.I UNDERSTAND THE INFORMATION LISTED BELOW:

1. I must be admitted to the Tech Teaching Program.
2. ALL required PRAXIS II and PLT scores must be sent to the State of Louisiana AND Louisiana Tech University. Make certain you mark those when registering.
3. I will follow the school district calendar as a resident so I will start the residency in August before fall quarter begins.

CRRC PRAXIS RESOURCES:
1. FREE Praxis Study guides for check out (Monday - Thursday between 9 a.m. - 3 p.m. or email to arrange pick up).
2. 240 Tutoring is a simulated online study tool and strongly recommended. Join with a discount from latechcrrc.org page.

RESIDENCY COSTS:
Residency Certificate: no cost (When: May 2026)
Liability Insurance through APEL membership: approx. $25 (When: July 2026)
SWIVL membership: approx. $95 (When: August 2026)
Background Check: most are provided by your districts
Watermark Assessment Membership: No cost if you have already joined.

TEAM MODEL CLINICAL RESIDENCY NEXT STEPS (TIMELINE):

NOVEMBER 2026
- Submit online Residency Application to the CRRC.

DECEMBER 2026
- RSVP to the CRRC Mid-Year Recruitment Event - held Friday, January 16, 2026, at the Davison Athletic Complex.

JANUARY 2027
-Participate in Mid-Year Recruitment
-Participate in CRRC Residency Interview Process

FEBRUARY/MARCH 2027
- Submit Residency District Requests.
- Check Tech email daily for communication from the CRRC.
- Update Mrs. Birch at crrc@latech.edu when you have evidence of Praxis registration or passing scores. Tech receives official passing scores approximately 2 weeks later. If you do not pass an exam, also reach out so we can provide additional resources and provide support in selecting next test date.

APRIL 2027
- Those with passing official Praxis scores will be able to register for residency during advising for fall quarter in April/May.
- Attend April TEAM Model Workshop - Date TBA.

MAY 2027
- Submission of Residency Certificate application and State Background Check. CRRC will submit to the Louisiana State Department of Education.

JUNE 2027
- Louisiana Tech should receive all official passing scores for Praxis II and PLT no later than June 1. Admission to residency, clinical placements, and registration for fall quarter residency class will only be finalized for those meeting this requirement.

Yes

No

24.Attach a Preferred Photo (headshot - to be used in upcoming district/school announcements)

No file chosen

25.Additional Comments/Questions.

26.I understand that I will not be allowed during spring advising to register for residency, be placed for residency, or begin residency until all requirements are met for admission to the TEAM Model Clinical Residency Program. If scores are not received in time to submit state required residency application, residency program will be deferred to following academic year.

Date / Time

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27.I certify that the information submitted above is true and accurate. On this date, I submit my 2026-2027 TEAM Model Clinical Residency Application.