GRADUATE
Student Teacher Application
College of Education, Office of Field Services
Select Semester/Year:
Select Placement Area:
___ Fall 20_____
___ Spr 20_____
___ Mobile ___ Saraland City ___ Out of Area
___ Baldwin ___ Satsuma City
(See OFS for Policy)
JAG #: J00___________________ Social Security #: ___________________ Date of Birth: ___________
Applicant Name: _______________________________, _________________________ ________________
Last
First
Middle
PHOTO
REQUIRED
If not already taken
by OFS
Local Address – This address is used to determine school placements only and does not affect your address with the University
_________________________________________________________ ____________________________ ______ ______________
Street Address
City
State
Zip Code
Home Phone (____)____________ Cell Phone (____)____________ Email Address: ____________@jagmail.southalabama.edu
(*ONLY USA email address will be used for OFS communications)
SELECT MAJOR:
Alternative Masters:
___ P-3 Early Childhood Education
___ K-6 Elementary
___ K-6 Special Ed Collaborative
___ 6-12 English/LA
___ 6-12 Gen Science/Biology/Chemistry/Physics
___ 6-12 French
___ P-12 French
___ 6-12 German
___ P-12 German
___ 6-12 Spanish
___ P-12 Spanish
___ 6-12 Mathematics
___ 6-12 Social Studies
___ 6-12 Special Ed Collaborative
___ P-12 Art Education
___ P-12 English for Speaker of Other Languages (ESOL)
Masters/Class B Certification:
___ 6-12 English/LA
___ 6-12 Gen Science/Biology/Chemistry/Physics
___ 6-12 French
___ 6-12 German
___ 6-12 Spanish
___ 6-12 Mathematics
___ 6-12 Social Studies
Regular Masters/Class A Certification:
___ K-6 Special Ed Collaborative
___ 6-12 Special Ed Collaborative
___ P-12 English for Speakers of Other Languages (ESOL)
If you have any children/relatives in a local school district, please complete the following:
School District: ___ Baldwin ___ Mobile ___ Saraland ___ Satsuma
School Name(s) & Grade(s): __________________________________________________________________________
If you are currently employed as a teacher and will fulfill this requirement in your own classroom, please complete the
following:
School Name: ______________________________________ Principal’s Name: _________________________________
COMMENTS:______________________________________________________________________________________________
___________________________________________________________________________________________________________
LIST ALL PREVIOUS FIELD EXPERIENCE:
Placement Type
(i.e., Practicum, Methods)
Semester/
Year
School
Grade/
Subject
Cooperating
Teacher
University
Supervisor
Note: Please attach a degree evaluation for your advisor.
__________________________________
Student’s Signature
1/12/15
____________
Date
_______________________________________
Advisor’s Signature for Recommendation
___________
Date
**PLEASE READ THE FOLLOWING AND SIGN**
Internship Applications must be filed with the Office of Field Services at least one semester in advance of the planned
internship. LATE APPLICATIONS MAY RESULT IN DELAYED INTERSHIP.
•
Fall Semester student teaching deadline to turn in application is February 28th.
•
Spring Semester student teaching deadline to turn in application is September 30th.
~LIST OF REQUIREMENTS THAT MUST BE COMPLETED BEFORE INTERNSHIP~
REQUIREMENTS FOR ALL TEACHER CERTIFICATION
(For complete text of policy, reference current USA Bulletin)
1.
Achieve Graduate status.
2.
Achieved passing score on APTT/AECTP and required Praxis II tests.
3.
Verification of clear background check.
4.
Proof of current Professional Liability Insurance (n/a if already employed as a teacher). It may be necessary for you to
provide a copy of your Liability Insurance receipt as proof of coverage.
5.
Digital photo (if not already taken by OFS).
6.
Completion of appropriate methods/practicum course for this field.
7.
Recommended for student teaching by faculty advisor. Advisor’s signature on application is required.
8.
Internship Course Registration. Completing this application does not register you for your internship course.
ALT / ELEMENTARY & EARLY CHILDHOOD
1.
Completed appropriate methods course for this field?
Curriculum Planning / EEC 522 or 553
Instructional Planning / EEC 523
Reading Methods / RED 530 OR 531
Practicum / EEC 557
MAJORS – Additional Requirements
___ General Science / EEC 537
___ English/Language Arts / EEC 532
___ Mathematics / EEC 535
_ _ _ Tests, Measurement, & Evaluation / EPY 525
ALT / ENGLISH FOR SPEAKERS OF OTHER LANGUAGES MAJORS – Additional Requirements
1.
Completed appropriate methods course for this field?
o
ESOL Class A
ELT 525 ___
o
ESOL Alternative Class A
ELT 525 ___
SED 555 ___
ELT 530 ___
ELT 545 ___
ELT 553 ___
ELT 558 ___
ELT 530 ___
SED 559 ___
ELT 545 ___
ELT 553 ___
ELT 558 ___
ALT / SECONDARY EDUCATION MAJORS – Additional Requirements
1.
Completed:
SED 555
SED 559
2.
Completed appropriate methods course for this field?
o
English/Language Arts
SED 553 ___
o
Foreign Language
SED 553 ___
o
General Science
SED 556 ___
o
Mathematics
SED 554 ___
o
Social Science
SED 557 ___
ALT / SPECIAL EDUCATION ALTERNATIVE
1.
Completed appropriate methods course for this field?
o
Sp Ed Class A K-6
SPE 589 ___
o
Sp Ed Class A 6-12
SPE 589 ___
_______________________________
Student Signature
1/12/15
– Additional Requirements
SPE 512 ___
SPE 512 ___
_________________
Date
SPE 514 ___
SPE 514 ___
SPE 516 ___
SPE 516 ___
SPE 591 ___
SPE 591 ___
RETURN COMPLETED FORM TO:
University of South Alabama, College of Education
Field Services, UCOM 3600
Mobile, AL 36688
Phone: 251-380-2739 Fax: 251-380-2728
Office of