Application for Student Teaching (Practicum)
Fall Semester: Due March 1
Spring Semester: Due October 1
(Late and/or incomplete applications may be denied)
UMB Student ID Number:
Grad / Undergrad:
First Name:
Last Name:
Other Official Name
(e.g. Maiden):
Street Address:
City:
State:
Zip:
Phone Number:
Email:
Massachusetts Educator’s License sought (include discipline and level):
(Middle/Secondary only) – I am interested in obtaining Middle AND Secondary Licensure.
Where did you complete your pre-practicum? (School Name, City)
I am awaiting results for one or more MTEL exams.
Identify MTEL test(s) pending and scheduled testing date:
Communications & Literacy
Subject matter MTEL
Foundations of Reading
General Curriculum – Multi-Subject
General Curriculum – Math
Early Childhood
Are you currently working as a Teacher of Record, Aide, or Paraprofessional?
If you answered yes, where are you currently working? (School Name, City)
I currently hold and have attached a copy of the following MA Teaching Licenses:
 License field:
 License number:
Last Updated: April 2015
Please check ONE of the following:
I am currently teaching in the position sought for licensure
I am in need of assistance in finding a placement in an urban school district
In most cases, we place students at their pre-practicum school. If there is a circumstance in which you need
to request a change, please obtain the “Practicum Change Request Form” from our office and submit it with
this application.
Transportation:
I have a car
I rely on public transportation
Please submit the following documents attached to this application to:
Danielle Wheeler, Field Placement Coordinator
teachered@umb.edu
Office of Teacher Education (Wheatley 02-093)
Applications will be denied and returned if ALL required information has not been submitted.
Copy of ELAR Activity Summary Page
ELAR Summary of MTEL scores
WISER schedule of courses you are currently taking and any previous courses required for the
education program highlighted
Documentation for any required courses for which you’ve been granted a waiver
Documentation of at least 75 pre-practicum hours
Copy of your cooperating teachers’ license(s)
Copy of your resume
Elementary teaching level only: photocopy of health workshop attendance
Teachers of Record, Aides, & Paraprofessionals: Attach a detailed practicum proposal with
this application. Include information such as the name of your practicum site(s), cooperating
teacher(s), and your plan to distribute your practicum hours
Special Education only: Attach detailed practicum proposal with this application. Include
information such as the name of your practicum site(s), cooperating teacher(s), and your plan to
distribute hours as required by UMass Boston (PreK-8; 400 hours in an inclusive setting or 75
hours in an inclusive setting and 325 hours in a separate or sub-separate setting for students with
moderate disabilities. 5-12: 400 hours in an inclusive setting or 150 hours in an inclusive setting
and 250 hours in a separate or sub-separate setting for students with moderate disabilities.
I have read and completed all areas of the application and provided all required documentation as requested
(and per program / department, if applicable). I understand that I am not to find my own placement as all
placements are secured through the Office of Teacher Education.
Signature: ________________________________________________ Date: _________________________
Last Updated: April 2015