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Application for Student Teaching(All Licensure Programs)Name:Email:Local Address:Cell Phone:If you are from Ohio, what high school/district did you attend?Advisor:Licensure Program:____Elementary Education____Inclusive Elem. Education____Middle Childhood____Special Education____Integrated Science for Teachers____Adolescent to Young Adult____MultiageCumulative GPA:Education Courses GPA:If MC, AYA, MA Content Area:_________________________GPA: _____________MC Content Area #2: _________________________________GPA: _____________Have you been fully admitted into the Teacher Education Program? FORMCHECKBOX Yes FORMCHECKBOX NoIf no, please explain:Please note schools where you were placed for your previous field experiences:EDUC 251EDUC 300.5EDUC 300.18EDUC 300.20EDUC 349EDUC 369Other:Do you have a car? FORMCHECKBOX Yes FORMCHECKBOX NoAre you willing to drive another student to a placement? FORMCHECKBOX Yes FORMCHECKBOX No(Check all that apply) For your student teaching placement, are you interested in: FORMCHECKBOX Preschool FORMCHECKBOX Elementary FORMCHECKBOX Middle FORMCHECKBOX High School FORMCHECKBOX Career Tech CenterGrade Level Preference: FORMCHECKBOX PK FORMCHECKBOX K FORMCHECKBOX 1st FORMCHECKBOX 2nd FORMCHECKBOX 3rd FORMCHECKBOX 4th FORMCHECKBOX 5th FORMCHECKBOX 6th FORMCHECKBOX 7th FORMCHECKBOX 8th FORMCHECKBOX 9th FORMCHECKBOX 10th FORMCHECKBOX 11th FORMCHECKBOX 12th(Check all that apply) Which types of schools interest you? FORMCHECKBOX Public School FORMCHECKBOX Private School FORMCHECKBOX Charter School FORMCHECKBOX Urban FORMCHECKBOX Rural FORMCHECKBOX Suburban FORMCHECKBOX I don’t know which type of school FORMCHECKBOX I am interested in student teaching in ChicagoAre you planning to play a sport, work, or take classes while student teaching?If yes, please explain:Is there anything else you would like me to know that is relevant to, and would help me place you in your student teaching placements? ................
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