SUNY Cortland Physical Education Student Teaching
Coaching/Extra-Curricular Assignment Form
Complete one form for each of your placements and submit them to your College Supervisor.
Name_______________________________________ ST semester ____________________________
1st placement ______ or
2nd placement______
School District______________________________________________________________________
Employee’s phone number_____________________________________________________________
This is the same school district at which I am placed: yes______ no______
Reason for coaching assignment outside of assigned student teaching placement:
__________________________________________________________________________________
__________________________________________________________________________________
Sport or Cocurricular Activity
Employed Coach or
Teacher
Level of
Competition
Dates
Days per
Week
Provide the athletic director at each assignment with copies of the fronts and backs of your First Aid, CPR, and
AED certification cards prior to beginning your coaching assignment.
The personnel responsible for coaching supervision will be asked to complete an appraisal form at the end of the
assignment. You can find the Coaching Appraisal Form on the website.
The above information has been discussed with the school district’s athletic director and/or principal. I will
notify my College Supervisor of any changes throughout the semester.
Student teacher’s signature_______________________________________ Date_________________