Application for
Student Teaching
Deadline for Fall 2011: November 1, 2010
Deadline for Spring 2012: April 1, 2011
LATE APPLICATIONS WILL BE ASSESSED A $50.00 FEE
Directions: Complete the form by typing into the shaded portions. Save the file, print it, sign where indicated, and
meet with your adviser for his/her signature. Add attachments as requested and submit complete application to the
Education Department office by the deadline indicated to avoid being charged a late fee of $50.00.
Name:
Phone:
Advisor:
Address:
Major:
Elementary (K-8)
Music (K-12)
Secondary (5-12)
Art (K-12)
Physical Education (K-12)
Endorsement(s) that will be completed by the time of graduation—refer to the on-line GV
catalog for number(s) and title(s):
1.
I plan to student teach:
Fall 2011
Spring 2012
2. I have completed (or will complete PRIOR TO my student teaching semester) all coursework for
my major and at least one of my endorsements:
Yes
No
3. GPA Status:
a. My cumulative GPA is 2.5 or higher.
b. My GPA is 3.0 or above for all coursework in my major.
c. My GPA is 3.0 or higher in EACH of my endorsements.
d. My grades for all major and endorsement courses are C or higher.
Yes
Yes
Yes
Yes
No
No
No
No
NOTE: If you answered "No" to any question in #3, please provide a typed explanation on an attached 8 ½ x 11 sheet of paper
describing how the deficiency(ies) will be resolved PRIOR to student teaching. If the deficiency is not resolved, you will not be
eligible to student teach as planned. Sign and date the explanation.
4. The following documents are attached to this application:
a. Documentation of a TB test taken within the last three years
b. Copy of my Petition for Graduation
(with accompanying program and endorsement evaluations)
Yes
Yes
No
No
If you have already received a response from the Registrar’s Office regarding the status of your petition— approved
or not approved— , also attach a copy of the audit sheet. If you have not yet submitted a Petition for Graduation,
download the form from
https://myview.grandview.edu/academics/graduation/Lists/DocumentLibrary/Petition%20for%20Graduation,
complete the form, and meet with your adviser prior to submitting it to the Registrar. Attach a copy here.
c. Autobiographical Essay
Yes
No
Summarize how the preparation you have received to date has given you the necessary knowledge, skills, and
dispositions to be a competent student teacher. What has your courses and practica taught you about teaching?
What beliefs do you have about teaching? This essay will be shared with your cooperating teachers as a means of
introduction. Limit your essay to one typed page,12-point, 1-inch margins. Be sure to spell check your essay and
have your adviser proof read your work. The Writing Lab is also a great resource to use prior to submitting your
essay to your adviser. You’re selling yourself to a potential employer, so put your best foot forward.
Application for Student Teaching Fall 2011/Spring 2012
Updated 10/10
Grand View Student Teaching Application, page 2
5. Assurances:
a. Have you ever been convicted of a felony?
b. Have ever been convicted of a crime other than parking or speeding
violations (report any OWIs)?
c. Do you currently have any pending criminal charges against you?
d. Have you ever had a founded report of child abuse made against you?
e. Have you ever had an educational license denied, revoked or suspended?
f. Are you a United States citizen?
g. Have you ever been charged with a violation of the GV Student
Code of Conduct?
Yes
No
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
Yes
No
NOTE: If you answered "Yes" to any question in #5 (other than f.), please provide a typed explanation on an attached 8 ½ x 11 sheet
of paper explaining the circumstances in detail, including dates, how resolved, etc. Sign and date the explanation.
6. Certification:
I certify that the information provided on this application is full, true, and correct to the best of my knowledge and that no
information required to be given, either expressly or by implication, has been knowingly withheld. I understand that
answering questions erroneously or providing false information on this application is grounds for dismissal from the Teacher
Education Program at Grand View University and may jeopardize my eligibility for a teaching license in Iowa.
Applicant’s Signature:
Date: _______________
Advisor’s Signature:
Date: _______________
7. Factors Affecting Student Teaching Placements:
a. Particular Schools—The Iowa Department of Education recommends that teacher education students have as
many different opportunities as possible to observe and interact with students and teachers in a variety of school
districts, buildings, and classrooms. They further recommend that student teachers not be placed in schools they
attended, where they completed practicum experiences, where their children attend(ed), or where close relatives
are employed. Therefore, the following information is needed to make the best student teaching placements for you.





HS you attended (if located in Iowa):
MS/JHS you attended (if located in Iowa):
ES you attended (if located in Iowa):
School(s) your children attend(ed) (if located in Iowa):
School(s) where close relatives work (if located in Iowa):
b. Practicum Placements—Please list your practicum placements below.
 First Practicum Experience (District/School/Teacher):
 Second Practicum Experience (District/School/Teacher):
 Additional Practicum(s) required for endorsement(s) [District/School/Teacher]:
c. Specific Endorsement Requirements—Student teacher placements must also satisfy licensure requirements
by the Iowa Department of Education and the Board of Educational Examiners as well as Grand View University
Teacher Education Program requirements for the specific endorsement(s) being pursued. For example, elementary
education majors must student teach at both the primary and the intermediate levels. Students earning a special
education endorsement will student teach 8 weeks in a special education classroom and 8 weeks in a regular
classroom. Earning the PreK/K endorsement at Grand View requires an additional two weeks of student teaching,
for a total of 18 rather than 16 weeks of student teaching. This extra time allows for three placements of six weeks
each in a PreK, K, and Intermediate classroom. The additional two weeks can be accommodated within both the
Fall and Spring semesters with minor adjustments in the start and ending times for the student teaching experience.
Secondary education majors at Grand View are placed eight weeks at the middle school/junior high level and eight
weeks at the high school level, unless the endorsement being earned is taught only at the high school level (for
example, Biology). During the student teaching semester, students operate according to the schedule of the
assigned school and district, rather than according to Grand View’s course schedule. Art, Music, and Physical
Education K-12 majors receive both an elementary and a secondary school placement.
Application for Student Teaching Fall 2011/Spring 2012
Updated 10/10
Grand View Student Teaching Application, page 3
d.
Preference For Student Teaching Placements: Students should not attempt, under any circumstance, to arrange
their own student teaching placements. Student teaching assignments are finalized by the Education Department of
Grand View University in conjunction with local school district administrators. Each school district has its own
procedure for identifying experienced teachers who are qualified to be cooperating teachers, who are
recommended by their principals, and who are personally willing to accept a student teacher. Placements are
becoming more and more difficult to secure in some districts. Therefore, once placements are made, changes will
not occur unless an extenuating circumstance develops and is one that cannot be resolved successfully.
Students may indicate a preference for a particular placement, but placement in a preferred district cannot be
guaranteed. Final placement decisions will be made based on prior practicum placements, availability of
cooperating teachers in each district, major/endorsement requirements, and other factors as recommended by the
Iowa Department of Education, the Board of Educational Examiners, and the Grand View University Education
faculty.
Indicate below your 1st, 2nd, and 3rd choice of districts for your student teaching experience, keeping
in mind where your practicum placements were located. It is Grand View’s goal to give every
Education student field experiences in at least three different districts between practicum and student
teaching placements.
Adel-Desoto-Minburn
Des Moines Public Schools
Norwalk
Waukee
Ankeny
Grimes Center/Dallas
Saydel
Ballard/Huxley
Johnston
Southeast Polk
Bondurant-Farrar
North Polk
Urbandale
Private/parochial school
No preference
West Des Moines
NOTE: Out-of-the-area (greater than 20 minutes) and out-of-state placements are rarely made and only under extenuating
circumstances. Such placements are discouraged due to rising gas prices and difficulty in providing adequate weekly
supervision. A specific request for such a placement must be made in the space below and a detailed rationale for the request
must be included. Living in area outside of the Des Moines Area is not considered a valid reason for an out-of-area
placement unless undue hardship can be documented. Simply making the request does not guarantee approval. A follow-up
meeting to discuss your request will be scheduled by Mrs. Brindle. Such a request will only be considered if an extenuating
circumstance exists, if an appropriate placement can be found, and if adequate weekly supervision can be arranged.
An additional fee is charged for placements beyond a twenty minute drive of Grand View University ($750) and for
out-of-state placements ($1,500 or more, depending on the cost charged for contracted supervision). This fee is not a part of
tuition costs and must be paid by check/money order directly to the Education Department prior to the start of the student
teaching experience.
Specific Request & Reason(s) for the request:
Please list below any extenuating circumstances, not otherwise described, that would prohibit you from student teaching in a
particular district:
8. For Your Information:
a. Student teaching is considered a full time commitment.

Additional coursework may not be taken along with student teaching.

Student teachers follow the same daily schedule as their cooperating teacher and must be available for
additional duties as assigned.

Attendance at after-school, on-campus student teaching seminars on designated dates is mandatory.

Student athletes should plan their student teaching experience in the off semester of their sport. As a rule,
student athletes may not participate in their sport the semester of student teaching.

Students should also avoid or severely limit their involvement in other extracurricular activities that could
potentially interfere with fulfilling student teaching responsibilities.

Employment during student teaching is strongly discouraged.

Exceptions to current policy and practice will be considered on a case by case basis. Any extenuating
circumstance that conflicts with these guidelines should be explained here:
b. Students may student teach with up to 6 hours of General Education requirements yet to be completed. List any
Application for Student Teaching Fall 2011/Spring 2012
Updated 10/10
General Education course work you plan to take AFTER student teaching:
Application for Student Teaching Fall 2011/Spring 2012
Updated 10/10