CALVIN COLLEGE STUDENT TEACHING APPLICATION
Fall 2016 - Spring 2017
Last Name:
First Name:
Preferred First Name:
ID #:
For Office Use Only
Date Rec’d _______
Application # _____
Date:
Maiden Name, if applicable:
(Or list future married name and date if change will occur between now and student teaching)
Local Address:
Local Phone:
E-Mail Address:
Check if cell phone.
Expected Grad. Date (date when all program requirements have been met):
May
Aug
Dec
(List year)
Do you plan to participate in a Calvin Varsity sport or coach during the stu teaching semester? YES
If so, which sport:
NO
List high school (and city and state) you attended. Also list elementary school, if in West Michigan:
Will you be participating in an Off Campus Study Program (ie: Study in Spain) between now and student
teaching:
Spring 2016
Fall 2016
Location:
Educ 302-303 field placement: School:
Grade Level:
I still need to complete Educ 302-303. Please list semester:
Subject Area (if MS/HS):
Criminal Background Checks: All students need to complete background check prior to the student teaching semester.
More information will be e-mailed to you.
I will comply with this requirement and be responsible for the fee.
I will register for CPR/First Aid training prior my to student teaching semester.
The Michigan Department of Education requires the following information from all applicants for
Michigan Teacher Certification:
Have you ever accepted responsibility in a civil infraction (excluding speeding tickets) or been convicted of (or
pled no contest to) a misdemeanor or felony? Yes
No
Do you currently have any charges pending? Yes
No
Have you ever had a teaching, school counselor, school psychologist, or school administrator certificate denied,
suspended, revoked, surrendered, or nullified? Yes
No
If you answered “yes” to any of the above questions, please send a signed explanation to the Director of
Teacher Education. It is your responsibility to notify the Director of Teacher Education of any misdemeanor or
felony charges and convictions while you are a student at Calvin. Failure to disclose any misdemeanor or
felony constitutes fraud on this application and could result in dismissal from the Teacher Education Program.
Check your Student Teaching Program:
Elementary:
List subject area Major:
or Minors:
Secondary:
List Major:
Minor:
K-12 (PE, Art, Music, Spanish) List Major:
Minor:
Check Semester(s) for Student Teaching:
Elementary (Gen Ed) or Secondary Ed.
Special Education
Early Childhood (Preschool setting only)
Fall 2016
Spring 2017
Spring 2017
Interim 2017 (confirm with Prof. Verwys)
Fall 2017
Check if you are interested in any of the following possible Off-Site Student Teaching Programs. Please do not
select more than two locations. At this time these options are possibilities only. Final sites will be determined in the
spring 2016 semester.
These student teaching placements require an additional application and approval process. Selection will be based
on order in which application was received/GPA/recommendations and possible interviews.
Chicago Semester Program (Elem only)
New Mexico (Rehoboth Chr or area public)
Chandler (Phoenix), Arizona (Chr)
Colorado (Denver Chr. or Valor Chr HS)
Fall 2016
Fall 2016
Fall 2016
Fall 2016
Spring 2017
Spring 2017
Spring 2017
Spring 2017
Please state your level of interest or any questions you may have regarding these options:
Elementary:
Rank in order (1st-3rd) your grade level preference:
- Grades 1-3
- Grades 4-6
- Middle School (6-8)
Secondary:
Rank in order your grade level preference:
- Middle School (6-8)
- High School
- Open to either grade level
Please understand that these are general requests only and all first choices are not always possible. Be flexible!
The Calvin College Education Program seeks to provide you with a well rounded Christian education with a
variety of school setting experiences. Please list with rationale, the particular type of school setting you prefer,
such as Christian, public or charter.
Include transportation/location issues if necessary. However, transportation is your responsibility.
SEND COMPLETED APPLICATION TO GWEN BUTEYN AT gb23@calvin.edu
Applications DUE: December 1, 2015. Any applications received after Dec. 1 will require a $30.00 late fee.
See Application Instructions for details.