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If you hold a Practitioner Issuance 1 (JEP) license, you must submit this form along with evaluations by the dates listed below for licensure completion. The evaluations should be from the period that you have been teaching.

May graduates-April 15
August graduates-July 15
December graduates -November 15

If you cannot upload all documents through Qualtric, please email evaluations and observations to Ms. Lanier at mlanier@memphis.edu.

Please provide the following information:

Name (First, Middle, Last)

Maiden Name (or N/A)

UUID Number (ex. U00123456)

Phone Number

UofM Email Address

School Email Address

Please select from the following: MAT degree seeking student or Graduate Non-Degree (Licensure ONLY) student?

MAT degree seeking student
Graduate Non-Degree (Licensure ONLY)
Master's program through another department but completed licensure requirements

Are you currently employed at a public or private institution?

Public
Private
Charter

Please provide the name of your school district and school name.