Student teachers must complete one term in an elementary school and the other term in a middle school or high school. In order to assist with your own placement, please propose four options: two elementary schools, one middle school, and one high school.

School district: ___ School: ___

Accreditation/Accrediting Body: ___ School population (#): ___

School population (#): ___

Principal: _____ Telephone: _____

Principal's e-mail: ___

School district: _____

School:

Accreditation/Accrediting Body: _____ School population (#): _____

Principal: _____ Telephone: _____

Principal's e-mail: ___

School district: _____ School: _____

School:

Accreditation/Accrediting Body:

School population (#):

Principal: _____

Telephone: _____

Principal's e-mail: ___

School district: _____ School: _____

Accreditation/Accrediting Body: ___ School population (#): ___

Principal: _____ Telephone: _____

Principal's e-mail: ___

Student Teacher Applicant's Statement: I verify that the information in this application is current and accurate.

Applicant's signature: _____ Date: _____

Date: ___

Revised Spring 2018