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
in 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
Cell Phone (____)____________ Home Phone (____)____________ Email Address: ____________@jagmail.southalabama.edu
SELECT MAJOR:
Alternative Masters:
___ P-3 Early Childhood Education
___ K-6 Elementary
___ K-6 Special Ed Collaborative
___ 6-12 English/LA
___ 6-12 General 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 Speakers of Other Languages (ESOL)
Regular Masters/Class A Certification:
___ K-6 Special Ed Collaborative
___ 6-12 Special Ed Collaborative
___ P-12 English for Speakers 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
LIST ALL PREVIOUS FIELD EXPERIENCE:
Placement Type
(i.e., Practicum, Methods)
Semester/
Year
School
Grade/
Subject
Cooperating
Teacher
University
Supervisor
If you have any children/parents/siblings 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:______________________________________________________________________________________________
A degree evaluation must be attached for your advisor’s review. Advisor’s signature is required on application.
11/9/15
STUDENT NAME: _______________________________________
JAG#: J00 ___________________________
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 INTERNSHIP.
Fall Semester student teaching deadline to turn in application is February 28th
Spring Semester student teaching deadline to turn in application is September 30th
•
•
**STUDENT AND ADVISOR SHOULD REVIEW AND COMPLETE
CHECKLIST BELOW BEFORE SIGNING**
REQUIREMENTS THAT MUST BE COMPLETED BEFORE INTERNSHIP:

Achieve Graduate status. Attach a degree evaluation.

Internship course registration. Completing this application does not register you for your internship course.

Achieved passing score on APTT/AECTP and required Praxis II tests. Official scores must be reported to USA prior to student
teacher orientation. Required Praxis II tests by Program (see below):
Program
P-12 Art
P-3 Early Childhood
K-6 Elementary
6-12 English/LA, Foreign Language,
Science, Math, Social Studies
P-12 ESOL
K-6 Special Education
6-12 Special Education
Content
Knowledge
Yes
Yes
Yes
Yes
--Yes
---
Date Taken/
Score
Teaching
Reading
--Yes
Yes
Date Taken/
Score
---------
PLT
--Yes
Yes
Date Taken/
Score
---------
If Praxis has not been taken, date you plan to take it: ___________________________________________________

Verification of clear background status. Print and attach a copy of your background status (if not on file in OFS) from the
ALSDE portal at https://tcert.alsde.edu/Portal/Public/SearchCerts.aspx.

Proof of current Professional Liability Insurance. Print and attach a copy of your receipt (if not on file in OFS) showing
expiration date (www.nea.org).

Recommended for student teaching by faculty advisor. Advisor’s signature is required on application.

Completion of appropriate methods/practicum course for this field and/or additional requirements (see next page):
APPLICATION CONTINUED ON NEXT PAGE
11/9/15
ALT / ELEMENTARY & EARLY CHILDHOOD
MAJORS – Additional Requirements
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
___ 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
Completed appropriate methods course for this field?
o
ESOL Class A
ELT 525 ___
ELT 530 ___
ELT 545 ___
ELT 553 ___
ELT 558 ___
o
ESOL Alternative Class A
ELT 525 ___
SED 555 ___
ELT 530 ___
SED 559 ___
ELT 545 ___
ELT 553 ___
ELT 558 ___
ALT / SECONDARY EDUCATION MAJORS – Additional Requirements
Completed:
SED 555
SED 559
Completed appropriate methods course for this field?
o
o
o
o
o
English/Language Arts
Foreign Language
General Science
Mathematics
Social Science
SED 553 ___
SED 553 ___
SED 556 ___
SED 554 ___
SED 557 ___
ALT / SPECIAL EDUCATION
MAJORS – Additional Requirements
Completed appropriate methods course for this field?
o
o
Sp Ed Class A K-6
Sp Ed Class A 6-12
SPE 589 ___
SPE 589 ___
SPE 512 ___
SPE 512 ___
___________________________________ ____________
Advisor’s Signature for Recommendation
Date
RETURN COMPLETED FORM TO:
University of South Alabama
College of Education
Office of Field Services, UCOM 3604
75 N University Blvd, Mobile, AL 36688
Phone: 251-380-2739 Fax: 251-380-2728
11/9/15
SPE 514 ___
SPE 514 ___
SPE 516 ___
SPE 516 ___
SPE 591 ___
SPE 591 ___
___________________________________ ___________
Student’s Signature
Date