Elementary Student Teaching Application
Due at time of Student Teacher meeting in the fall
Student ID
Campus Box
Last Name
Current Address
First Name
Cell Phone
Home Address
Middle Initial
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 Yes If yes, list:
Email
Maiden Name
Home Phone
Elementary Education teaching major with endorsement(s) in:
Grade Level Preference:
Lower Upper
Ele 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:
School(s): Grade Level(s): Content:
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 No
TEP Deficiency:
I acknowledge I am responsible for transportation to and from my placement site.
_______________________________________________________________ Date ______________________

Student Teacher Signature
Elementary Student Teaching Application
Due at time of Student Teacher meeting in the fall
I acknowledge I am responsible for transportation to and from my placement site.