Saint Louis University : SLU



Name: Undergraduate Student: ___Graduate Student: ___Local Address: Phone: Home Address:Phone: Email Address: Emergency Contact:Schools Attended *These are the schools you attended as a student. Please include district if out of St. Louis area.Elementary: Middle: High School: Area(s) of Certification: ______________________________________________Teaching Level Desired:Early Childhood: Preschool ___K ___1-2 ___ 2-3 ___Elementary: Primary ___(1-3)/ Intermediate ___ (4-6)Middle (indicate areas of specialization):1. 2.Secondary (indicate teaching field):1. 2. Mild/Moderate (Placement in an Elementary Inclusive setting 14 weeks/ Placement in a Special Education setting 2-3 weeks): Primary ___ (1-3) / Intermediate ___ (4-6)Student Teaching Placement Request… LOCAL student teaching placements are made in accredited Missouri/ Illinois public and private schools, programs, and agencies within approximately one hour’s driving distance from campus. Other local and non-local placement sites may be assigned in accordance with individual program and/or student needs. All placements are based on availability and efficiency of appropriate supervision.The Office of Field Experiences may not request positions in specific school divisions, at specific schools, or with specific teachers. Under no circumstances will students try to secure their own placement(s).Please describe the student teaching setting you prefer. Be as descriptive as possible. This may include information related to type of school, urban/suburban, public/private, religious affiliation, socioeconomics, demographics, or school philosophy.________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Please state a minimum two-year grade range you would prefer: _____________________Please state any school for which you are ineligible (for example, schools attended or schools where relatives work or attend): ?____________________________________________________________________________________________________________________Comments or information that would be helpful in requesting your student teaching placement(s):____________________________________________________________________________Previous Teaching Experience (including private, public, pre-teaching):SemesterSchool/DistrictGradeHoursPublic/Private/CatholicUrban/Sub/RuralCourses Completed in Education (“*” indicates courses currently enrolled in):List courses by course # and title (EDSP 4310 – Education and Psychology of the Exceptional Individual)Content Courses Completed in Area of Certification (for middle and secondary students):List courses by course # and title (EDSP 4310 – Education and Psychology of the Exceptional Individual) ................
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