OTTERBEIN UNIVERSITY STUDENT TEACHING/INTERNSHIP APPLICATION PART 1
Semester / Year:
(select one)
Select Program:
Fall Semester 2015
Spring Semester 2016
Fall Semester 2016
Spring Semester 2017
Fall Semester 2017
Spring Semester 2018
Local Placement
Alternate Experience
Special Request
NAME
DATE OF APPLICATION
July 1, 2016
Program Major/Concentration Areas and Coursework
MAT Intervention
Early Childhood
Middle Childhood
Specialist
MAT Middle
AYA (Grades 7-12)
Multi-Age (Grades PK-12)
Childhood
EDUC 5970 Student
EDUC 4710 Student
EDUC 4810 MCHD
EDUC 5970 MAT Student
EDUC 4100 AYA/Multi-Age Student Teaching
Teaching
Teaching
Student Teaching
Teaching
EDUC 4110 SYE Seminar
EDUC 4720 SYE
EDUC 4820 SYE
Seminar
Seminar
Mild to
Early
Moderate
Middle Childhood (Grades 4-9)*
Childhood(PK-3)
Moderate to
Intensive
ECIS
Int. Lang Arts
Health Education
Int. Mathematics
Music Education
Int. Soc. Studies
Physical Education
Foreign Language
Concentration 1
Concentration 2
Lang Arts
Lang Arts
Life Sciences
Mathematics
Mathematics
Phys. Sciences
Science
Science
Chemistry
Soc. Studies
Soc. Studies
Physics
E. C. 4-5
Generalist
Other
Language:
Visual Art
*Middle Childhood majors; select the area of concentration you want to teach during student teaching.
Math
Social Studies
Science
LOCAL CONTACT INFORMATION
Language Arts
HOME CONTACT INFORMATION
LOCAL ADDRESS
HOME ADDRESS
LOCAL PHONE
HOME PHONE
E-MAIL ADDRESS
E-MAIL ADDRESS
HIGH SCHOOL ATTENDED
NAME
CITY
STATE
GRADUATION YEAR
OTHER COLLEGES ATTENDED
NAME
Student Teaching Application
MMF 01/29/2015
CITY
STATE
YR
Degree
RELEVANT HONORS RECEIVED
RELEVANT EXTRA CURRICULAR ACTIVITIES IN HIGH SCHOOL/COLLEGE
RELEVANT RECREATIONAL & HOBBY INTERESTS
RELEVANT WORK EXPERIENCE
PREVIOUS FIELD EXPERIENCE
SCHOOL
DISTRICT
DESCRIBE YOUR TEACHING STYLE.
Student Teaching Application
MMF 01/29/2015
GRADE LEVEL OR SUBJECT
DESCRIBE YOUR IDEAL COOPERATING TEACHER.
DESCRIBE THE TYPES OF EXPERIENCES THAT YOU WOULD PROFIT FROM DURING STUDENT TEACHING.
IN WHAT AREAS DO YOU NEED TO GROW TO “ROUND OUT” YOUR PROFESSIONAL TRAINING?
(E.G. KNOWLEDGE OF MATERIALS, CLASSROOM MANAGEMENT, PLANNING, INDIVIDUALIZATION OF INSTRUCTION, USE OF EDUCATIONAL TECHNOLOGY, VARYING
INSTRUCTIONAL DELIVERY, ASSESSMENT, ETC.)?
WHY DID YOU DECIDE TO TEACH?
Sign Here To Authorize the Education Department To Forward Your Unofficial Transcripts To School District(s)
Signature
Date
Enter Initials here to indicate Signature:
AUTHORIZATION
This application may be sent to ffastenau@otterbein.edu as an attachment to an email without your
signature. By sending this application you agree to have the application (and unofficial transcripts if
requested) sent to school districts to request a placement for student teaching. This application will also be
sent to your university supervisor and cooperating teacher.
Student Teaching Application
MMF 01/29/2015