Intent to Apply for PA Certification

Complete all fields, then click Submit. You will receive a confirmation screen and email when your form is successfully submitted. If you do not receive these confirmations, complete and submit the form again. If the problem continues, contact the Certification Office for assistance.

Student Information
First Name  is a required field.
Last Name  is a required field.
Student ID Number is a required field.
Street Address  is a required field.
City  is a required field.
State is a required field.
Zip Code  is a required field.
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Email Address(non-WCU) is a required field.
Last 4 Digits of Social Security Number  is a required field.
Area of Concentration is a required field.
Middle Grades Subject is a required field.
Middle Grades Subject is a required field.
Anticipated Graduation/Program Completion Date is a required field.