Student Teaching K-12 Application

Student ID:

Projected Blocks to Student Teach:

year:

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

Yes No

If yes, list:

K-12 education teaching major in:

I have additional endorsements in:

Math Science Social Studies English No additional endorsements

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