STUDENT TEACHING APPLICATION
All student teacher candidates MUST meet with their Program Advisor to submit applications to student
teach. The Program Advisors will submit completed and signed Student Teaching Applications to The
Office of Fieldwork Experiences by the due date.
APPLICATION TO ADVISOR DEADLINE:
APRIL 15 for spring applications
OCTOBER 15 for fall applications
SCHEDULE A MEETING WITH YOUR ADVISOR TODAY!
NAME _______________________________________ NAU EMAIL
NAU ID #________________________
@NAU.EDU
STUDENT TEACHING TERM _______________
The following is a checklist that should be used to ensure the application is completed prior to advisor meeting:
Student Teaching Application Check List:
 Completed Student Information/Placement Request form
 Completed Student Teacher Personal Data form
This page must be downloaded and completed prior to meeting with
your advisor.
Limit = 1 page
PEU OFFICE USE ONLY
STUDENT TEACHING APPLICATION
CHECK-IN
 FINGERPRINT CLEARANCE CARD
(Copy of both front and back)
 INFORMATION/PLACEMENT REQUEST
 PERSONAL DATA SHEET(TYPED-one page limit)
 Completed Statement of Understanding.
 SPECIAL REQUEST FORM
 A copy of transfer transcripts (If applicable)
 STATEMENT OF UNDERSTANDING
If you have coursework from a college other than NAU, bring those
transcripts if the courses are not listed on LOUIE.
For Special Requests Only:
(Make sure that each line has been initialed)
 OUT-OF-STATE/RODEL
RECOMMENDATION AUTHORIZATION
FORM (if applicable)
 Completed Special Request form - check all that applies
You must provide a rationale/justification for each request.
o Relative in District
o Out-of-State Student Teaching (limited programs only)
o Rodel Student Teaching
o Taking a course concurrently
o Elementary Ed student teaching in Middle School
 Signed Out-of-State/Rodel Recommendation Authorization form
(If applicable)
________________________________________________
Advisor’s Signature
 Additional Information Needed:
Date Received from Advisor:
___________________________
Received by:
__________________________
February 2015
Student Information/Placement Request Guidelines




All student teacher candidates must meet with their Program Advisor to submit a student teaching application.
Students requiring two placements (Dual, Music, Art and PE majors) must request the same districts for both placements.
Requests for specific cooperating teachers are not allowed.
All placement requests must be processed through The Office of Fieldwork Experiences. Attempting to make your own placement may
hinder the process or your opportunities.
 Requests to change initial request must be submitted by posted “change request” deadline.
 Requests for Out-of-State experiences must be on original application request only. (Available to limited programs.) Change
requests are allowed for Arizona schools only.
Grade Level Definitions:
Early Childhood:
 Preschool: birth up to kindergarten (Pre-K)
 Primary: kindergarten through third grade (K-3)
Elementary:
 Primary: first through third grade (1-3)
 Intermediate: fourth and fifth grade, could include sixth if all content classroom (4-5 and 6?)
 Middle: seventh and eighth grade 6-8 (must pass NES Middle Grade Content Exam prior to placement)
Secondary
 Middle: sixth, seventh and eighth grade (6-8)
 High: ninth through twelfth grade (9-12)
Student Teaching Application Components:
Placement Request Form

The information on this form is used to communicate the type of placement(s) and grade levels you need. It is important
that you fully complete the information required in these forms.

IMPORTANT! This form must be typed, limited to one page, and must have a professional appearance. This form is sent
to schools/districts and may influence their decision to accept your student teaching request. You can prepare the Personal
Data Sheet by listing each question and corresponding answer as a word processing document, making sure to include all
information requested on the form.

The Statement of Understandings contains important information regarding policies and procedures pertaining to student
teaching, graduation, and certification. Please read each statement carefully before initialing. If you have any questions
regarding the statements, please ask your Program Advisor.
Personal Data Sheet
Statement Of Understandings
Special Request Form
The following are considered Special Request situations. If any of these apply to you, a Special Request form must be
completed and submitted. Special Requests are subject to stipulations and approval. This form is included within packet.

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


Relative in District
Out-of-State Student Teaching – Not available for most majors. Ask your Program Advisor for details.
Rodel Student Teaching –Available to limited majors and only in the Flagstaff and Phoenix metro area.
Taking a non-content Course Concurrently with student teaching (must be a graduation or certification requirement of
program)
Middle School Placement for Elementary Majors
February 2015
STUDENT TEACHING PLACEMENT REQUEST:
TERM ONE
Last Name
First Name
ID#:
Middle Name
Other Name(s)
State ZIP
Phone #
E-mail Address:
Permanent Address
City
Content Emphasis
(Elementary or Early Childhood majors only)
Secondary Major/Certification Area
(Majors preparing to teach in grades 6-12 only)
Minor (if applicable)
Student Type (Check one):
Program (Check all that apply):
Undergraduate
M.Ed.
Early Childhood
Elementary
Secondary
Special Education:
High Incidence
Low Incidence
Early Childhood
PLACEMENT REQUESTS GUIDELINES
The following requests will be submitted to the district and/or school listed. Representatives of those offices make all placement decisions. The Office of Fieldwork
Experiences reserves the right to confirm the location and cooperating teacher for your student teaching assignment. You MUST provide a first and alternate request.
 All Student Teaching Candidates must complete the placement A section.
 Student Teaching Candidates in the following programs must select two types of placements, and therefore must also complete the Placement B section:
o
Early Childhood majors must request a placement for both Preschool and Primary grades
o
Elementary and Special Education majors must request a placement for both Elementary and Special Education classrooms
o
Secondary P.E. majors must request placement at both an Elementary and Secondary School
o
Secondary Music majors must request a dual placement in Elementary and Middle School or High School, or Middle School and High School
o
Art majors who wish to student teach at both an Elementary and Secondary School must request placement at both an Elementary and Secondary School
PLACEMENT A -- Request for student teaching placement:
Placement type:
Early Childhood 
Special Ed 
Elementary

Secondary 
ESL

District/State:
Alternate request for placement A student teaching placement:
School:
School:
Early Childhood
Preschool (Pre-K) ____
Primary (K-3)
____
Elementary
Primary (1-3) ____
Intermediate (4-6)____
(all content)
Secondary
Middle School (6-8) ____
High School (9-12) ____
(content specific)
District/State:
Early Childhood
Preschool (Pre-K) ____
Primary (K-3)
____
Elementary
Primary (1-3) ____
Intermediate (4-6)____
(all content)
Secondary
Middle School (6-8) ____
High School (9-12) ____
(content specific)
PLACEMENT B -- Request for student teaching placement:
Placement type:
Early Childhood 
Special Ed 
Elementary

Secondary 
ESL

District/State (must be same as placement A):
Alternate request for placement B student teaching placement:
School:
School:
Early Childhood
Preschool (Pre-K) ____
Primary (K-3)
____
Elementary
Primary (1-3) ____
Intermediate (4-6)____
(all content)
Secondary
Middle School (6-8) ____
High School (9-12) ____
(content specific)
District/State:
Early Childhood
Preschool (Pre-K) ____
Primary (K-3)
____
Elementary
Primary (1-3) ____
Intermediate (4-6)____
(all content)
Secondary
Middle School (6-8) ____
High School (9-12) ____
(content specific)
Student Teaching Term Requirement Statement (sign and date if applicable)
I acknowledge that my certification and degree requirements require only one term of student teaching.
___________________________________
____________________________________________
_______________
Printed Name
Signature
Date
February 2015
STUDENT TEACHING PLACEMENT REQUEST:
TERM TWO
If more than one term is needed to complete program/degree requirements, you must complete the Term Two Student Information/Placement Request.
Last Name
First Name
ID#:
Middle Name
Other Name(s)
E-mail Address:
PLACEMENT REQUESTS
The following requests will be submitted to the district and/or school listed. Representatives of those offices make all placement decisions. The
Office of Fieldwork Experiences reserves the right to confirm the location and cooperating teacher for your student teaching assignment.
You MUST provide a first and alternate request.
*See term one for placement request specific guidelines.
PLACEMENT A -- Request for student teaching placement:
Placement type:
Early Childhood 
Special Ed 
Elementary

Secondary 
ESL

District/State:
Alternate request for placement A student teaching placement:
School:
School:
Early Childhood
Preschool (Pre-K) ____
Primary (K-3)
____
Elementary
Primary (1-3) ____
Intermediate (4-6)____
(all content)
Secondary
Middle School (6-8) ____
High School (9-12) ____
(content specific)
District/State:
Early Childhood
Preschool (Pre-K) ____
Primary (K-3)
____
Elementary
Primary (1-3) ____
Intermediate (4-6)____
(all content)
Secondary
Middle School (6-8) ____
High School (9-12) ____
(content specific)
PLACEMENT B -- Request for student teaching placement:
Placement type:
Early Childhood 
Special Ed 
Elementary

Secondary 
ESL

District/State:
Alternate request for placement B student teaching placement:
School:
School:
Early Childhood
Preschool (Pre-K) ____
Primary (K-3)
____
Elementary
Primary (1-3) ____
Intermediate (4-6)____
(all content)
Secondary
Middle School (6-8) ____
High School (9-12) ____
(content specific)
District/State:
Early Childhood
Preschool (Pre-K) ____
Primary (K-3)
____
Elementary
Secondary
Primary (1-3) ____
Middle School (7-8) ____
Intermediate (4-6)____ High School (9-12) ____
Student Teaching Term Requirement Statement (sign and date if applicable)
I acknowledge that my certification and degree requirements require two terms of student teaching.
___________________________________
Printed Name
____________________________________________
Signature
_______________
Date
February 2015
PERSONAL DATA SHEET
This form will be forwarded to the administrator of each school or district to which your student teaching placement request is made. 1 page only
Last Name
First Name
Email address:
Local Address
Middle Name
Maiden Name
ID#
City
State
ZIP
Phone #
Teaching area for which you are seeking certification:
List colleges attended other than NAU:
List scholastic or extra-curricular activities or honors you have participated in or received:
How have your past accomplishments or experiences prepared you to be a teacher?
Describe your role as a future teacher:
Describe your classroom management plan:
Describe how to build a satisfying and productive relationship within the learning community:
SPECIAL REQUEST FORM
February 2015
Those not making a special request, please go to the Statement of Understanding.
Placement guidelines for requests:
 All student teacher candidates must meet with Program Advisor to submit a special request application.
 All supporting documentation must be submitted with the special request.
 Out-of-State and Rodel cannot be listed as alternate requests.
 Arizona districts are the only alternate options for Out-of-State and Rodel candidates.
Please note:
 Notification of decision will be emailed to your NAU EMAIL account
******************************************************************************************
NAME:
ID#:________________________
PHONE#:
EMAIL:
@NAU.EDU
Student Teaching Term:
MAJOR(S):
Early Childhood
Elementary Education
Special Education
Secondary Education
Indicate below which type of exception you are requesting.





Relative in District
Rodel Student Teaching – Only available in the Flagstaff and Phoenix metro area.
Taking a Course Concurrently with student teaching
Out-of-State Student Teaching – Not available for most majors. Ask your Program Advisor for details.
Middle School Placement for Elementary Majors (6-8 content specific)
Indicate Content Area:
 Social Studies
 Math
 English
 Science
February 2015
Check the appropriate special request and provide details to support your request in the
appropriate section. Special Requests submitted without supporting details will not be considered.
You may use an additional page if needed for rationale.
Relative in District
If you have any relatives in the district where you are requesting a student teaching placement, provide the
following information:
 Provide a rationale for consideration why this is the only placement available for you.
 Name(s) of your relative(s)
 Relationship(s)
 Grade/position
 District School
The committee will abide by the district policies regarding the appropriate placements for family members. A
letter from the school’s lead administrator supporting your request must be submitted for consideration.
Rodel Student Teaching – Only available to limited majors in Flagstaff and the Phoenix metro area
This is a highly competitive program. Requesting a Rodel placement does not guarantee a placement with Rodel. It is
highly recommended to visit http://www.rodelaz.org/ to learn more.
The following is a list of requirements for Rodel student teaching:
 Must have cumulative NAU GPA of at least 3.00 at the time of application.
 Provide a rationale for consideration to student teach with Rodel.
 Complete and sign the Recommendation Authorization form. This form will be used to solicit two NAU
faculty and one advisor recommendations (minimally).
 Complete and submit Rodel application. (This will be emailed to you once student teaching application
is processed.)
 Attend all required Rodel meetings.
 Interview with Rodel Committee.
o Resume
o Lesson Plan example
o Recent Trend in education for identified population
Taking a Course concurrently with student teaching (If approved, the course is limited to 3 units, online venue
only, and cannot be a required course for the teaching certificate.)
To take a course concurrently with student teaching, the following requirements must be met:
 Must have cumulative NAU GPA of at least 3.00 at the time of application.
 Must be an elective course and necessary for graduation or teaching certification of degree pursued
 Must be an online, evening, or weekend course
 Maximum of 3 units
 Provide the course number (i.e. MUS 100) and title (i.e. Introduction to Music).
 Provide the venue, location, time and place of the course. (Online, face2face, etc.)
 Provide rationale for taking course concurrently and why it was not taken prior to student teaching.
Note: No education, foundation, curriculum, or methods courses can be taken concurrently during student
teaching.
February 2015
Out-of-State (OOS) Student Teaching
This is only available to Elementary, Special Education, and Early Childhood majors. Ask your Program Advisor for
details.
To be eligible for an OOS placement, the following requirements must be met:
 Must have cumulative NAU GPA of at least 3.00 at the time of application.
 Provide a rationale for consideration to student teach outside of Arizona.
 Complete and sign the Recommendation Authorization form. This form will be used to solicit two NAU
faculty and one advisor recommendations (minimally).
 Attend all required Out-of-State meetings.
 Complete the Statement of Understandings for OOS student teacher candidates. (Provided at initial
meeting.)
 Adhere to any district policies regarding student teaching placements. (These may be additional to NAU
standard guidelines.)
 Interview with OOS Committee.
o Resume
o Lesson Plan presentation
o Recent Trend in education presentation
 Pay any additional costs that exceed the allocated amount for NAU for all student teachers,
cooperating teachers or university supervisors.
Note: Being “approved” does not mean that it is a guaranteed opportunity. OOS student teacher candidates often
do not know their exact student teaching placement until a short time before the actual student teaching is to
begin.
Middle School Placement for Elementary Majors (6-8 content specific classrooms)
To be eligible for a middle school placement, the following requirements must be met:
 Take the NES Middle Grade content exam(s) for the content(s) requested.
 Provide the passing score(s) for NES Middle Grade content exam(s).
Note: Elementary majors will only be allowed to student teach in these areas (with evidence of passing NES scores):
 Social Studies
 Math
 English
 Science
Student Teacher Candidate Signature _________________________________________
Date_______________
ID#:__________________
***********************************************
FOR OFFICE USE ONLY
___ Approve
___ Deny
Date: _____________________
February 2015
RECOMMENDATION AUTHORIZATION
RECOMMENDATION AUTHORIZATION
This form must be completed by students requesting a student teaching placement Out-of-State or Rodel
program. These program options may not be available to all student teacher candidates.
Please indicate which type of placement you are requesting:


Out-of-State Program
Rodel Program
As part of the evaluation process for a possible Out-of-State or Rodel placement, references will be
solicited from full-time NAU faculty members who have had you in their class.
Under the Federal Family Rights and Privacy Act of 1974, you are entitled to review your records,
including letters of recommendation. It is your option to waive the right of access to these
recommendations or to decline to do so. Please be aware that some faculty members may not complete a
recommendation form unless it is a confidential recommendation. Providing a recommendation is optional
for faculty.
Please mark the appropriate phrase below, indicating your choice of option, and sign your name. A copy
of this authorization will be given to each person from whom a recommendation is requested.

I DO waive my right to review this recommendation
[This means you choose NOT to review the recommendation]

I DO NOT waive my right to review this recommendation
[This means you DO choose to review the recommendation]
Date: __________
Applicant’s Name (Print):___________________________
Applicant’s Signature: ______________________________
Applicant’s Student ID Number: ______________________
February 2015
STATEMENT OF UNDERSTANDING
This document is to assist you in understanding your responsibilities as an NAU student teacher candidate in the Teacher
Education Program at Northern Arizona University. You must read and initial each of the following statements.
STUDENT TEACHING
NAME:__________________________________ NAU ID #___________________
TERM: ____________________________
STUDENT TEACHING PREREQUISITES:
_____ I understand I must be fully admitted to the Teacher Education Program.
_____ I understand I must complete all degree requirements prior to student teaching.
_____ I understand I must be approved for student teaching by faculty representatives of my major faculty.
_____ I understand all education coursework, with the exception of EDF 200, must not be older than 6 years at the time of
student teaching.
_____I understand that as a prospective student teacher, I must demonstrate social and emotional maturity consistent
with professional standards of classroom instruction as well as physical health for teaching. If a serious question is
raised through university classes, personal conduct or contact in the schools, the Office of Fieldwork Experiences
reserves the right to request an individual diagnostic evaluation (medical or psychological) prior to or during student
teaching. If an evaluation is required, I understand that I will be responsible for all related expenses.
_____ UNDERGRADUATE ONLY I understand I must have a minimum cumulative grade point average of 2.50 in all
professional education courses, with no grade lower than a C, and I must also have an NAU cumulative grade point average of
at least 2.50 before a student teaching placement will be made. (Some programs have additional GPA requirements.)
_____ GRADUATE ONLY I understand I must have an NAU graduate cumulative grade point average of at least 3.00, with
no more than two C’s before a student teaching placement will be made.
STUDENT TEACHING PLACEMENT REQUIREMENTS:
_____ I understand that I must possess a valid Arizona Fingerprint Clearance card.
I understand that I must provide a copy of the front and back of my valid Fingerprint Clearance card to the Program
Advisor.
I understand that I must complete and submit my student teaching application by the posted due date.
_____ I understand that I must submit any special requests with my student teaching application as indicated therein.
_____ I understand that special requests may be denied.
_____ I understand that all elementary education majors requesting a middle school content placement must provide passing
NES scores for content areas requested (grades 6-8).
_____ I understand that I cannot request a reduction of student teaching time.
_____ I understand that I must provide verification that all degree requirements have been successfully completed before I may
begin my student teaching experience.
_____ I understand that all placement change requests may only be honored if submitted prior to February 1st for fall student
teaching and September 1st for spring student teaching.
_____ I understand that neither I nor anyone on my behalf can make direct contact with district/school personnel to inquire or
secure a student teaching placement.
_____ I understand I may not request a specific cooperating teacher or grade for my student teaching placement.
_____I understand my cooperating teacher may not be a relative and that any time spent in the classroom with a relative as the
cooperating teacher will not count towards student teaching hours, and my placement will be terminated.
February 2015
I understand that if I am requested to schedule and attend an interview for a placement, I will do so immediately and
notify the Office of Fieldwork Experiences upon completion.
_____ I understand that if I am pursuing an out-of-state placement I must follow the instructions provided by the Office of
Fieldwork Experiences.
_____ I understand that there may be an additional fingerprint clearance process required by the district/school and that I must
incur all costs associated with this process.
____ Secondary majors only: I understand my secondary education content faculty my override my placement request.
STUDENT TEACHING GENERAL INFORMATION:
_____I understand Office of Fieldwork Experiences reserves the right to select the location and cooperating teacher for
my student teaching placement.
_____I understand that it is my responsibility to check my NAU EMAIL account, on a regular basis, for all student teaching
correspondence.
_____
I understand I must view the Student Teaching Orientation in BbLearn.
_____ I understand that all Student Teaching coursework, assignments, evaluations, and survey are located in BbLearn and
that it is my responsibility to interact within BbLearn and NAU email on weekly basis.
_____ I understand that my first responsibility is to the students in my student teaching classroom.
_____ I understand that it is my responsibility to notify the Office of Fieldwork Experiences of any changes to my confirmed
original placement immediately as this could jeopardize confirming my degree and receiving an Institutional Recommendation.
_____ I understand it is my responsibility to register for student teaching before I begin student teaching and that there is a
fee associated with each course for student teaching.
_____I understand that it’s my responsibility to provide the following information to a district/school if required:
Immunization Records with MMR, current TB test, high school diploma or GED, Fingerprint Clearance Card – copy of both
front and back.
_____I understand that a full-time student teaching day is comprised of student contact time and cooperating teacher mentoring
time, which is approximately 8 hours per day.
_____I understand I must complete 80 days, as aforementioned, for one term of full-time student teaching. This could consist
of two 40-day placements in one term.
I understand that I can only complete a maximum of one 80-day or two 40-day placements in one term. I will register
for the appropriate section(s) of student teaching I intend on completing for that term only. I further understand that it may be
necessary to register for and complete additional placements in the following term, if required for my degree.
_____ I understand if I do not register for student teaching prior to beginning student teaching, any time spent in the classroom
will not count towards student teaching hours and my placement will be terminated.
_____ I understand it is my responsibility to read the Teacher Candidate Handbook prior to entering the classroom. The
Handbook provides a common frame of reference for all stakeholders in the student teaching experience.
_____ I understand that I must successfully complete all criteria as outlined in the student teaching syllabus.
_____ I understand it is my responsibility to actively communicate with my assigned cooperating teacher and university
supervisor.
February 2015
_____ I understand it is my responsibility to know and adhere to the policies of the district and school where I am student
teaching.
_____ I understand that I may be removed from my student teaching placement if I choose to disregard the policies of the
district and school where I am student teaching.
_____ I understand it is my responsibility to read and sign the “Statement of Values and Expected Professional Behaviors”
when I meet with my university supervisor.
_____ I understand it is my responsibility to adhere to the disposition statement in the “Statement of Values and Expected
Professional Behaviors” document.
_____ I understand it is my responsibility to read, complete, sign, date, and submit all student teaching documents within
BbLearn for the Office of Fieldwork Experiences to have official record of my student teaching experience.
_____I understand it is my responsibility to inform Office of Fieldwork Experiences of changes in name, address, and
telephone number after I have submitted my application.
_____ I understand it is my responsibility to view and download my evaluations which are located within BbLearn.
_____I understand that I cannot be financially compensated for my student teaching experience.
_____I understand that professional and general liability are provided by State Risk Management Section to students enrolled in
approved university internship/externship programs who are acting in good faith and within the course and scope of their
programs. No medical liability is covered under this section.
_____I understand that as an active student teacher, I must demonstrate social and emotional maturity consistent with
professional standards of classroom instruction as well as physical health for teaching. If a serious question is raised through
university classes, personal conduct or contact in the schools, the Office of Fieldwork Experiences reserves the right to request
an individual diagnostic evaluation (medical or psychological) prior to or during student teaching. If an evaluation is required, I
understand that I will be responsible for all related expenses.
_____I understand that if I do not complete my student teaching experience in the intended term, I will be required to update
my student teaching application and statement of understandings through the Office of Fieldwork Experiences.
GRADUATION REQUIREMENTS:
_____I understand that I will complete an additional application for graduation with my Program Advisor.
ARIZONA CERTIFICATION ELIGIBILITY:
_____I understand my degree must be posted to receive an Institutional Recommendation.
_____I understand I must pass the required Teacher exams as part of the Arizona Department of Education certification
process.
_____I understand it is my responsibility to submit the Institutional Recommendation to the Arizona Department of Education
along with all required documents to receive a Provisional Teaching Certificate.
I confirm I have read, understood, and initialed each of the items listed above and that it is my responsibility to retain a copy of
this document for my records. I am aware if I do not initial each item, my application for student teaching will not be accepted.
The violation of the aforementioned Statement of Understandings may result in the postponement or cancellation of student
teaching, which would impact graduation and certification.
Print Name
Signature
ID#_____________________
Term:______________
February 2015