Special Education Licensure Program

Mild Intervention Licensure Application

Welcome to the official application for admission to the Mild Intervention Licensure program.

Please complete each field and click "submit". Items marked with an asterisk are required. If the web browser is closed prior to submission, the information entered will be lost. It will take approximately 30 minutes to complete the application.

Please note that this application is only one part of the overall process. If you have any questions, please contact the office by calling 800.845.3149 or email online@taylor.edu.

* - you must fill out ALL REQUIRED FIELDS to submit your enrollment successfully.

Personal Information


TIN Requirement: Per federal law, students must supply their TIN (Social Security Number) to their university so that it may be included on 1098T information reported to the IRS for potential tax credit. Students who did not provide their SSN when registering for courses with Taylor University should do so by completing the Form W-9S and submitting to 3201 Stellhorn Road, Box C130, Fort Wayne, IN 46815. Fax number is 260-744-8796. Form W-9S link http://www.irs.gov/pub/irs-pdf/fw9s.pdf

Contact Information

Demographic Information

Prior Education/Licensure Information

References

Verification

Upon candidate completion of above conditions, the candidate will be eligible for admission to the Mild Intervention Licensure Program as a guest student at Taylor University. By entering my name, I understand and will comply with the requirements to be admitted to the Mild Intervention Licensure Program at Taylor University. I certify that the information provided is accurate and complete.



This application is only one piece of the material required for applying to the Mild Intervention Licensure Program. Please go to the "Admissions" page for more information.