CHANGE OF TERM
STUDENT TEACHING APPLICATION
All student teacher candidates MUST meet with their Program Advisor to submit “change of term”
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.
This “Change Application” is for students who have already applied for student teaching and need to
change their intended term of student teaching.
New Term APPLICATION TO ADVISOR DEADLINE:
JANUARY 20 for fall placement
AUGUST 20 for spring placement
SCHEDULE A MEETING WITH YOUR ADVISOR TODAY!
NAME _______________________________________ NAU EMAIL
CAMPUS
@NAU.EDU
NAU ID #________________________
STUDENT TEACHING TERM _______________
The following is a checklist that should be used to ensure the
application is completed prior to advisor meeting:
PEU OFFICE USE ONLY
STUDENT TEACHING APPLICATION
CHECK-IN
 FINGERPRINT CLEARANCE CARD
(Copy of both front and back)
Student Teaching Application Check List:
 Completed Current Student Information/Placement Request form
 INFORMATION/PLACEMENT REQUEST
 PERSONAL DATA SHEET(TYPED-one page limit)
 SPECIAL REQUEST FORM
 Completed Current Statement of Understanding.
 STATEMENT OF UNDERSTANDING
(Make sure that each line has been initialed)
 OUT-OF-STATE/RODEL
RECOMMENDATION AUTHORIZATION
FORM (if applicable)
 Additional Information Needed:
Date Received from Advisor:
___________________________
Received by:
________________________________________________
Advisor’s Signature
Date
__________________________
February 2015
Change of Student Teaching Term
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.
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 Updated Application:
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.

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.
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.


Relative in District
Middle School Placement for Elementary Majors
February 2015
CHANGE OF TERM
STUDENT TEACHING APPLICATION
INTENDED STUDENT TEACHING TERM:
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
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 1 st 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.
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.
February 2015
_____ 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.
_____ I understand it is my responsibility to know and adhere to the policies of the district and school where I am student
teaching.
February 2015
_____ 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
ID#_____________________
Signature
Term:______________
February 2015
Special Request Form
Placement guidelines for special 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.
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.
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