Elementary Student Teaching Application Student Contact Information

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Elementary Student Teaching Application
Due at time of Student Teacher meeting in the fall
Student Contact Information
Student ID
Last Name
First Name
Campus Box
Current Address
Cell Phone
Middle Initial
Email
Home Address
Student Teaching Information
Projected Blocks to Student Teach (3 consecutive):
Year:
Please Note:
14 consecutive weeks of student teaching are
required for certification. If you student teach the
first block, you must return to campus when your
host school begins in-service, often in mid-August. If
the experience is 2,3,4 or 3,4,5 or, 4,5 6, you must
return to campus in January when your host school
begins, often the first week of January. If you are
living on-campus, housing will be provided, but you
will not have a meal plan prior to Cornell resuming
classes.
Do you have any course below a C in your
Education professional core or endorsement?
NO
Ele
Maiden Name
Home Phone
Elementary Education teaching major with endorsement(s) in:
Grade Level Preference:
Lower
Upper
Yes If yes, list:
Elementary Education K-8: endorsement area:______________________________________________
(e.g. mathematics, language arts, social studies, science, art, physical education, music)
List the courses you will be taking to meet the endorsement requirement. Include course number and name.
__________________________, ________________________________, _____________________________
__________________________, ________________________________, _____________________________
__________________________, ________________________________, _____________________________
Elementary Student Teaching Application
Due at time of Student Teacher meeting in the fall
•
•
•
If a specific teacher requested you as a student teacher, please indicate the teacher’s name, grade, school:
Identify any extracurricular activity you will be involved in during student teaching:
Other information that may be helpful in making my placement:
Practicum Experience(s)
School(s):
Grade Level(s):
Content:
Approval of Major Department (Elementary Education Professor)
My signature represents a positive recommendation for this individual as a prospective member of the
profession. I believe this person possesses ethical and moral values consistent with professional standards
promoted by the College and for teacher licensure, as well as human qualities that will elicit positive responses
from stakeholders.
___________________________________________________ Date____________________
Signature
I have concern(s) in relation to the above recommendations.
___________________________________________________________________________
___________________________________________________________________________
Department Use Only:
GPA________________ Field Experience Approved___________________________ Admitted to TEP
TEP Deficiency:
No
I acknowledge I am responsible for transportation to and from my placement site.
_______________________________________________________________ Date ______________________
Elementary Student Teaching Application
Student Teacher Signature
Due at time of Student Teacher meeting in the fall
I acknowledge I am responsible for transportation to and from my placement site.
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