Student Teaching Secondary Application

Student ID:

Projected Blocks to Student Teach:

Please Note

14 consecutive weeks of student teaching are required for certification. If you student teach the first block, you must return to campus when your host school begins in-service, often mid-August. If the experience begins in blocks 2-4, you must return to campus in January when your host school begins, often the first week of January. If you are living on-campus, housing will be provided, but you will not have a meal plan prior to Cornell resuming classes.

Year:

Do you have a course below a C in your education professional core or endorsement?:

Yes No

If yes, list:

Secondary teaching major in:

I have additional endorsements in:

Math Science Social Studies English No additional endorsements

Practicum Experiences

Schools:

Grade Levels:

Content:

Did a specific teacher request you as a student teacher?:

Yes No

If yes, please indicate the teacher's name, grade and school:

Identify any extracurricular you will be involved in during student teaching:

Any other information that may be helpful in making your placement?:

I acknowledge that I am responsible for transportation to and from my placement site:

Yes

Student Teacher Signature:

* Required Field

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