EIU EDS On-Campus OR Off-Campus Cohort - Interest Form

Please complete this form if you are interesting in completing your Specialist in Education - Educational Administration program (Superintendent's Endorsement)

THIS IS NOT an official admission request form (please visit www.eiu.edu/myeiu to apply).

* - Required fields

On- or Off-Campus preference -- full VIRTUAL/ONLINE delivery (via zoom/teams & D2L) *

If your cohort location isn't available, please contact the Educational Leadership Department for more information about the possibility of new cohorts starting in your location. Phone: 217-581-2919 or E-mail: edadmin@eiu.edu
When do you plan to begin taking EDS courses? (SEM/YR; i.e. Summer/2025) *
Name Name * First Last
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Cell Phone Cell Phone * - ### - ### ####
Home Email *
Work Email *
School & district currently employed *
Position(s) held *
Years of teaching experience *
Locations of teaching experience
Years of administrative experience *
Locations of administrative experience *
Do you currently work in a public school district? *

Do you currently work in a public school district? Yes No
Career goal in 5 years *
Career goal in 10 years
Do you plan on becoming a public school superintendent?

Do you plan on becoming a public school superintendent? Yes No
If Yes,

If Yes, Within the next year Within the next 3 years Uncertain
Are there any special considerations we should be aware of in regard to your admission to our program?