University of Northern Iowa
Out-of-State/International Student Teaching
Non-UNI Application
Personal Information
Last Name / First Name College or University Campus Address – Street, City, State, Zip
Phone Number -
Cell Phone -
Permanent -
Campus -
Permanent -
Permanent Address – Street, City, State, Zip
E-Mail Birthday (MM/DD/YYYY)
Education Information
Major (1) -
(2) -
Minor (2) -
(2) -
Identify the grades/subjects for your placement
through UNI
Semester you will be student teaching
Fall 201
-
Approximate starting and ending dates for your
placement through UNI (as approved through your home university)
Start date:
Spring 201
End date:
Professional Website address:
Name of contact person at your home university:
(this is the person who should be notified of your placement details)
Title:
Address:
Phone:
Email:
Student Teaching Preferences
Site preference for your student teaching (can be specific or general as per your request)
Choose either “INTERNATIONAL” OR “OUT OF STATE”
INTERNATIONAL
Choose one
1. Country -
City -
DoDDS
American International School
Host Country
2. Country -
City -
DoDDS
American International School
Host Country
3. Country -
City -
DoDDS
American International School
Host Country
OUT-OF-STATE
1. STATE -
City -
School / District -
2 STATE -
City -
School / District -
3. STATE -
City -
School / District -
Length of placement at selected site
st
1 Placement for 8 Weeks
2nd Placement for 8 Weeks
Page 1 of 2
16 week placement
University of Northern Iowa
Out-of-State/International Student Teaching
Non-UNI Application
1. What do you want to accomplish as a teacher?
2. Describe any unique skills and talents you have which would be helpful to you as
a teacher.
3. Why do you want to do your student teaching in an out-of-state or international
setting?
(mark “X” here)
I believe that I have the qualities to become a successful teacher. Further, I understand
that my progress and performance will be subject to evaluation in accordance with
generally accepted practices in the location I am requesting. I am aware that I am fully
responsible for my own transportation to and from the site, living arrangements, and
living expenses. I am aware that placements on individual timelines and I will be
informed as information becomes available about my placement.
Placing an X next to the above statement indicates your approval and confirmation that
all of the above information is accurate.
Date:
Page 2 of 2