Student Teaching Application - Early Childhood Program | College of Education

1 Start 2 Page Break 3 Complete

I am applying for *

Spring 2021

Fall 2021

Last Name *

First Name *

Middle Initial

Present cohort site *

Phone *

UA Student ID *

Local Address (Apt. No) *

City/State/Zip *

Permanent Address (Apt No)

Permanent City/State/Zip

UA Email *

Alternative Email

Have you ever been convicted or pled “No Contest” for any violation of the law other than minor traffic violations? *

Yes

Race/Ethnicity

Current Semester Status *

Undergraduate

Post-Baccalaureate

Are you an international student? *

Yes

Seniors, please identify your preschool and elementary placement sites & mentors. Juniors identify your current site.

In the event that a previous practicum placement is not available as a student teaching placement, we would like to know your preferences. Please describe below any district, school or teacher placement you may prefer and why.

	1	2	3
K	K - 1	K - 2	K - 3
1st	1st - 1	1st - 2	1st - 3
2nd	2nd - 1	2nd - 2	2nd - 3

Student Teaching Placement Policy

I understand it is against University policy to be placed for student teaching where my children attend school or relatives are employed. *

Yes

Permission for Release of Information

School Districts frequently request student information for student teaching placements and job opportunities. This may include, but is not limited to name, address, phone number, email, student teaching packet information, and unofficial transcripts. *

I authorize the Director of Student Services and/or the Director of Field Experiences to release information for placement and job opportunities.

I DO NOT authorize the Director of Student Services and/or the Director of Field Experiences to release information for placement and job opportunities.

Leave this field blank