SITI Agreement Form - Bagwell College

Agreement Form

Please fill out the agreement form below agreeing to the recognition statements listed. Thank you!

If you see this don't fill out this input box.

Today's Date:

Full Name:

KSU #:

Address 1:

Address 2:

City / Sate / Zip Code:

Email Address:

Phone Number:

Recognition Statement #1

I have read, understand, and agree to Recognition Statement #1, which states the following:

I understand that I do NOT have a GaPSC Professional Certificate, and therefore, I am not eligible for certification in Instructional Technology offered by the GaPSC.

Recognition Statement #2

I have read, understand, and agree to Recognition Statement #2, which states the following:

I understand that I am not eligible for an upgrade to my teaching certificate from the GaPSC, since I do not have a GaPSC Professional certificate.

Recognition Statement #3:

I have read, understand, and agree to Recognition Statement #3, which states the following:

I understand that the degree in Instructional Technology may not lead to a pay increase from my school or district since I do not have a GaPSC Professional certificate.

Recognition Statement #4:

I understand that if I were to attain a GaPSC Professional certificate in the future, that I may still not be eligible for certification in Instructional Technology since I did not have a GaPSC Professional certificate at the time I enrolled in the Instructional Technology degree program at KSU.

Electronic Signature:

Entering my first name, middle initial, and last name in the box above indicates my electronic signature on this form.

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