LICENSURE ONLY -- SCHOOL LIBRARY MEDIA COORDINATOR

APPLICATION FORM

If you wish to apply for the certification program for school library media coordinators provided by the School of Information and Library Science, please complete the form below and submit it.
If you have any questions, contact Program Director Dr. Sandra Hughes-Hassell directly at email: smhughes@email.unc.edu or by telephone: 919-843-5276.

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Name:
First Name: * Last Name: * Suffix:
Contact Information:
Email: *
Telephone: (Day): * (Night):
Street Address:
City/Town: State: Zip code:
Date of Birth: (MM/DD/YY)
Prior Education:
Do you have an MLS? Yes No
If yes, list degree name, school and date received:
If no, list related master's degree(s) e.g. M.Ed., Ed. Media, Instructional Technology, and the like:
Education Courses:
Please list below any education courses you have taken either at the graduate or undergraduate level. Please include course number, title, date completed.
Library Science courses:
Please list below the library science courses you have taken. Please include LIS school, course number, title, and date completed.
Licensure:
If you have, or have had, a license in another teaching area and/or in another state, please list it here. Include state, license number, title, date received.
Relevant Experience:
Are you currently working as a media specialist? Yes No
Describe teacher/librarian experiences with title, places, and dates. Describe librarian experience (other than school library) with title, places and dates.
If not currently working, list name of school system, geographic loaction and dates where you worked as an SLMS
Additional Comments:
If you wish to provide additional information or have a question to ask, use the space below.

Thank you for submitting your application. This form will be sent to Program Director Dr. Sandra Hughes-Hassell (smhughes@email.unc.edu). If you do not hear from her within two weeks, please contact her by email or telephone (919-843-5276).