Rodel Promising Student Teacher
Application
Spring 2016
Instructions:
1.
2.
3.
4.
Download and complete this application on a computer using the fill-in form fields for each question.
Save your completed application and print a copy. Mail, e-mail, or hand-deliver to one of the following:
Arizona State University
Northern Arizona University
Grand Canyon University
Debbie Robinson
Mary Lou Fulton Teachers College
Debbie.Robinson@asu.edu
Marilee Eveleth
College of Education
PO Box 5774
Flagstaff, AZ 86011-5774
Marjaneh Gilpatrick, Ed. D.
College of Education
3300 W. Camelback Rd.
Phoenix, AZ 85017
Scottsdale Community College
University of Phoenix
Rio Salado College
Mary Ellertson, M.Ed
Teacher Education Partnership
9000 E. Chaparral Rd.
Scottsdale, AZ 85256
Alfonso Alva, Ed.D.
College of Education
Alfonso.Alva@phoenix.edu
(602) 557-2138
Paulina Ngo
2323 W. 14th St, Tempe, AZ 85281
paulina.ngo@riosalado.edu
(480) 517-8414
Arrange to have two professional references (Appendix A) completed and mailed to your university.
Application materials are due by September 30, 2015.
Section I:
FirstName:
M.I.:
Student teaching semester and year:
University:
Student ID #:
Address:
City:
Home Phone:
Student E-mail:
Degree Program:
Undergraduate
Last Name:
Campus:
Current GPA:
State:
Masters
Program Area Information:
Check all that apply
Elementary Education – Grades 1-8
Secondary Education – Grades 7-12
Content Area Approval: Middle School Math
Content Area Approval: High School Math
Special Education– Grades K-8*
Special Education/Elementary Education
Early Childhood Education – Grades K-3*
Early Childhood/ Elementary Education
Zip:
Cell Phone:
Alternate E-mail:
Post-Bac
Other:
EndorsementsYou are Seeking:
Check all that apply
Bilingual Education Endorsement
English as a Second Language
Early Childhood Endorsement – Grades K-3*
Mathematics Specialist (K-8)
Middle Grade Teacher (5-9)
Other:
Please indicate information about your student teaching requirement: (Check all that apply)
Student teaching:
Fall
Spring 20
Additional Certification seeking:
_______________________
ASU Students
Term 7/Block 3(1st Sem. Stud Teach.) - Fall
Term 8/Block 4(2nd Sem. Stud Teach.) - Fall
MAC Student - Fall Spring 20
One Semester Only Student Teacher - Fall
Rodel Promising Student Teacher Application – Spring 2016
Rodel Foundation of Arizona, 6720 N. Scottsdale Road, Suite 310, Scottsdale, AZ 85253
Tel 480 367 2920
Fax 480 348 0502
www.rodelaz.org
rodel@rodelfoundations.org
Spring 20
Spring 20
Spring 20
Page 1 of 6
Preferences for student teaching:
Please prioritize the following placement opportunities by writing a number from 1 – 8, (1 being the most preferred; 8 being
your least preferred) in the column next to the school district.
District
School
Grade/Subject
Rodel Exemplary Teacher
___
Alhambra District
Granada Primary
Third Grade
Ms. Christie Pentkowski
___
Chandler Unified District
Conley Elementary
Sixth Grade
Ms. Jasmine Muniz
___
Cartwright District
Justine Spitalny Elementary
Special Ed
Ms. Maria Henry
___
Chandler District
Sanborn Elementary
Sixth Grade
Ms. Leticia Rodriguez-Davis
___
*Flagstaff District
Mt. Elden Middle
Middle School
Science
Mr. Chris Hull
___
*Flagstaff District
Lura Kinsey
First Grade
Ms. Katrina Collins
___
*Flagstaff District
Sturgeon Cromer
Third Grade
Ms. Rebecca Cardon
___
*Flagstaff District
Mt. Elden Middle
Middle School
Language Arts
Ms. Lee Irby
___
*Flagstaff District
John Q. Thomas
Fifth Grade
Ms. Laurie Jeffers
___
*Flagstaff District
W.F. Killip
Kindergarten
Ms. Michelle Novelli
___
*Flagstaff District
Puente de Hozho
Second/Third Grade
Ms. Pam White-Hanson
___
*Flagstaff District
Sinagua Middle School
Middle School
Social Studies
Ms. Veronica Villegas
___
Glendale Elementary
William C. Jack
Third Grade
Ms. Stephanie Lund
___
Isaac District
Mitchell Elementary
Second Grade
Ms. Zenaida Estrada
___
Salt River Pima-Maricopa
Community Schools
Salt River Elementary
School
Middle School Math
Ms. Kristi Carter
___
Mesa Public Schools
Jefferson Elementary
Fourth Grade
Ms. Leslie Hernandez
___
Mesa Public Schools
Whitman Elementary
Fifth Grade
Ms. Tiffany Thompson
___
Mesa Public Schools
Porter Elementary
Third Grade
Ms. Rosanne Carlson
___
Paradise Valley Schools
Palomino Intermediate
Sixth Grade
Mr. Jorge Ontiveros
___
Paradise Valley Schools
Larkspur Elementary
Fifth Grade
Ms. Michelle Perryman
___
Saddle Mountain District
Ruth Fisher Elementary
Middle School Math
Ms. Martha Hacker
___
Roosevelt School District
Cloves C. Campbell
Fourth Grade
Ms. Tasha Smith
___
Scottsdale Unified District
Yavapai Elementary
Second Grade
Ms. Brianna Maxwell
___
Tempe Union District
Desert Vista High
High School Math
Mr. Adam Scalettar
___
Tolleson District
Porfirio Gonzales
Pre-School
Ms. Brenda Thomas
___
Tolleson District
Desert Oasis Elementary
Pre-School
Ms. Audra Damron
*Only NAU students are eligible for Flagstaff placements.
Rodel Promising Student Teacher Application – Spring 2016
Rodel Foundation of Arizona, 6720 N. Scottsdale Road, Suite 310, Scottsdale, AZ 85253
Tel 480 367 2920
Fax 480 348 0502
www.rodelaz.org
rodel@rodelfoundations.org
Page 2 of 6
Please comment on your preferences for student teaching, and how flexible you can be with location and type of placement:
Major cross streets of residence when student teaching:
Please comment on your willingness/ability to commute to your student teaching site:
Rodel Promising Student Teacher Application – Spring 2016
Rodel Foundation of Arizona, 6720 N. Scottsdale Road, Suite 310, Scottsdale, AZ 85253
Tel 480 367 2920
Fax 480 348 0502
www.rodelaz.org
rodel@rodelfoundations.org
Page 3 of 6
Section II:
Describe your reasons for wanting to participate in this partnership. What talents, abilities, and attributes do you possess that
would benefit the students in high-need schools? (A high-need school is one with 70% or more of the students receiving free
or reduced lunch.) What is your commitment to this population/program?
Rodel Promising Student Teacher Application – Spring 2016
Rodel Foundation of Arizona, 6720 N. Scottsdale Road, Suite 310, Scottsdale, AZ 85253
Tel 480 367 2920
Fax 480 348 0502
www.rodelaz.org
rodel@rodelfoundations.org
Page 4 of 6
Section III:
Please answer the following three questions.
1.
Share information about your hobbies, interests or things you enjoy doing in your spare time.
2.
Share one experience you had with a teacher who impacted you most.
3.
What would you like the Rodel Exemplary Teacher to know about you?
Rodel Promising Student Teacher Application – Spring 2016
Rodel Foundation of Arizona, 6720 N. Scottsdale Road, Suite 310, Scottsdale, AZ 85253
Tel 480 367 2920
Fax 480 348 0502
www.rodelaz.org
rodel@rodelfoundations.org
Page 5 of 6
I understand that:
Only complete applications will be reviewed. Applications should include two professional references, at least one from a
university faculty member (Appendix A).
Application materials will be shared between personnel from the Rodel Foundation and your university.
The sample Contract (Appendix B) is similar to what I would be asked to sign if named a Rodel Promising Student
Teacher.
To qualify for the $2,500 award, I will have to comply with the terms listed in the sample Contract (Appendix B). This
would include successful completion of the student teaching assignment with a Rodel Exemplary Teacher, signing a
teaching contract by the school year following completion of student teaching, and completion of three full consecutive
years teaching in a high-need school in the state of Arizona.
If selected, I will be required to attend four Mandatory Seminars as a Rodel Promising Student Teacher.
Applicant’s Name
Date
Rodel Promising Student Teacher Application – Spring 2016
Rodel Foundation of Arizona, 6720 N. Scottsdale Road, Suite 310, Scottsdale, AZ 85253
Tel 480 367 2920
Fax 480 348 0502
www.rodelaz.org
rodel@rodelfoundations.org
Page 6 of 6
Rodel Foundation of Arizona
6720 N. Scottsdale Road, Suite 310
Scottsdale, Arizona 85253
(480) 367-2920, www.rodelaz.org
APPENDIX A
Rodel Promising Student Teacher
PROFESSIONAL RECOMMENDATION/NOMINATION
An electronic version of this form is available at www.RodelAZ.org. Follow the link for the Promising Student Teacher
Application.
Student’s Name ______________________________________________________________________________________
Last name
First name
University and Campus
Please respond to the following questions:
1.
What is your relationship to this student? _______________________________________________________________
2.
How long have you known him/her? ___________________________________________________________________
3.
How well do you feel you know this student? ____________________________________________________________
4.
On a scale of 1-5 (one = lowest, and 5 = highest), please circle the number that best describes the student:
5.
Maturity
1
2
3
4
5
Ability to make independent decisions
1
2
3
4
5
Dependability
1
2
3
4
5
Judgment
1
2
3
4
5
Self-confidence
1
2
3
4
5
Teaching ability
1
2
3
4
5
Responsibility
1
2
3
4
5
Probability of successful student teaching
1
2
3
4
5
Initiative
1
2
3
4
5
Academic competence
1
2
3
4
5
Please indicate one of the choices below:
___ I recommend this student as a Rodel Promising Student Teacher with no reservations.
___ This student may be able to be a successful Rodel Promising Student Teacher.
___ I do not recommend this student as a Rodel Promising Student Teacher.
6.
Comments (Use reverse side for additional comments, if necessary.)
____________________________________ __________________________ _____________________________________
Print Name
Position
Organization
____________________________________ ________________________________________________________________
Phone
Email
_______________________________________________________________ _________________ ______ ____________
Mailing Address
City
State
Zip
_______________________________________________________________ _____________________________________
Signature
Date
Please mail or hand-deliver recommendations to appropriate campus contact person:
Arizona State University
Debbie Robinson
Mary Lou Fulton Teachers College
PO Box 37100
Phoenix, AZ 85069
Northern Arizona University
Marilee Eveleth
College of Education
PO Box 5774
Flagstaff, AZ 86011-5774
University of Phoenix
Alfonso Alva, Ed.D.
College of Education
Alfonso.Alva@phoenix.edu
(602) 557-2138
Rio Salado College
Paulina Ngo
2323 W. 14th Street
Tempe, AZ 85281
paulina.ngo@riosalado.edu
(480) 517-8414
Scottsdale Community College
Mary Ellertson, M.Ed
Teacher Education Partnership
9000 E. Chaparral Road
Scottsdale, AZ 85256
Grand Canyon University
Marjaneh Gilpatrick, Ed.D.
College of Education
3300 West Camelback Road
Phoenix, Arizona 85017
APPENDIX B
Rodel Promising Student Teacher
Statement of Agreement
6720 North Scottsdale Road, Suite 310 - Scottsdale, AZ 85253 - 480-367-2920
This letter serves as verification of the agreement between the Rodel Charitable Foundation
of Arizona and the Rodel Promising Student Teacher named below.
Rodel Charitable Foundation of Arizona has named
Student Teacher
as a Rodel Promising Student Teacher.
In recognition of the accomplishments of the Rodel Promising Student Teacher and in
furtherance of its mission to improve the K through 12 education system in Arizona through
advancing teacher education and commitment to high-need areas, Rodel Charitable
Foundation of Arizona will provide the following to the Rodel Promising Student Teacher:
1. Facilitation of a student teaching assignment for a full semester with a Rodel Exemplary
Teacher.
2. Provision of continuing professional growth opportunities to facilitate successful student
teaching experience offered by Rodel and/or teacher preparation college.
3. Provision of continuing professional growth opportunities to facilitate successful teaching
placement and support offered by Rodel and/or teacher preparation college.
4. Award of $2,500 (cash or cash equivalent) to be presented at the conclusion of Rodel
Promising Student Teacher’s completion of Rodel Promising Student Teacher Terms of
Award listed below.
The Rodel Promising Student Teacher, also desiring to improve the K through 12 education
system in Arizona, agrees to the following (collectively the “Terms of Award”):
1. Successfully participate in all Rodel Seminars and/or teacher preparation college events to
facilitate successful student teaching. There will be a minimum of four mandatory Rodel
Seminars.
2. Accept and complete, with above average supervising teacher ratings, a student teaching
assignment with a Rodel Exemplary Teacher.
3. Receive a “passing” or better rating on the Rodel Promising Student Teacher Evaluation
Form completed by the supervising Rodel Exemplary Teacher.
4. Secure employment as a full-time certified teacher in a qualifying placement, beginning no
later than the start of the school year following student teaching. A qualifying placement is
defined as an Arizona school that serves a high-need target population having a 70% or
greater percentage of students qualifying for the Free or Reduced National School Lunch
Program (found in Arizona Department of Education reports).
5. Maintain qualifying employment (Term #4) for three consecutive full school years.
NOTE: Requests for hiatus from either Term #4 or #5 must be received, in writing, to
Rodel by October 1st of each academic year.
6. Maintain accurate contact information with Rodel.
7. Maintain active communication with Rodel by regularly updating address, email, phone, and
employment status. Read and respond promptly to email and postal mail from Rodel. Accept
responsibility to complete electronic surveys including, but not limited to:
a. Mid-Semester and End-of-semester Surveys
b. Annual Summer Employment Verification Survey
8. Assume full responsibility to verify that the student teaching assignment meets all timelines
and requirements for teacher licensing and endorsements as set forth by the Arizona
Department of Education.
9. Understand that placement with a Rodel Exemplary Teacher is made at the discretion of the
Rodel Charitable Foundation of Arizona and is subject to change or cancellation.
10. Understand that in such case that the placement is cancelled due to unforeseen
circumstances the student teacher will no longer qualify for the awards specified in this
agreement.
11. Agree to allow supervising teacher to release all pertinent evaluation materials to Rodel for
review as deemed necessary to administer program.
12. Agree to allow the Rodel Charitable Foundation of Arizona to release addresses, phone
numbers and other contact information to other participants and partners in the Rodel
Exemplary Teacher Initiative as deemed necessary to administer the program.
13. Agree to allow the Rodel Charitable Foundation of Arizona and its partners to utilize
participants name and image as deemed necessary to promote and administer the program.
Rodel Promising Student Teacher Signature
Howard Paley, COO
Rodel Charitable Foundation of Arizona
Date
Date