DEAR TEACHER EDUCATION CANDIDATE:
As you know, Mineral Area College is committed to excellence in our teacher education program and has implemented background
check policy for or all our entering students in EDU/ECE classes that required observations. Due to area schools requiring background
checks for all visitors to the public schools and our dedication to providing highly qualified candidates, MAC will also be requiring
background checks for any student enrolled in an Education class (EDU) prior to the student’s being allowed to complete any field
experience. Failure to have this paperwork completed will delay your ability to complete field experience and related class assignments
during the semester.
Before you pursue a degree in education, you need to be aware that if you have a criminal record, even if you have completed all your
coursework, you may be ineligible to obtain a teaching certificate.
If you have not already completed this paperwork, please 1.) Complete the following form and return it to:
Diana Stuart
PO BOX 1000
Mineral Area College
Park Hills, MO 63601
This process must be completed prior to completing field experience.
October 2014
If you do have a criminal record, before you will be allowed to participate in Mineral Area College’s Education Program, you must
attempt to reconcile any issues related to your criminal history. To do so, you must:
1.
Withdraw from or refrain from taking any/all EDU classes. You are responsible for any costs related to tuition and fees. You may
continue to take courses at MAC, but you may not enroll in any courses with the EDU prefix until this matter is resolved
satisfactorily. If you are able to resolve this matter, you will be able to enter the education program in the future.
2.
If necessary, consult your personal attorney to attempt to resolve any issues inaccurately reflecting your status.
3.
If you are able to resolve the issues related to your background, present documentation to the Coordinator of the Teacher
Education program in order to be considered for reinstatement into the program.
We appreciate your attention to this matter. MAC is proud of the teachers it is helping to train and aspires to serve the local
communities well with our students.
Direct any questions to Dr. Diana Stuart (573) 518-2252 or Diana@mineralarea.edu
Sincerely, Dr. Diana Stuart
Coordinator, Teacher Education Program
____________________________Please Sign and Return Bottom Portion_______________________
I,
(Please print)
___________________________________, agree that I must undergo and pass
a background check in order to participate in Mineral Area College’s Teacher Education
Program. I also understand that if my background check reveals ANY inappropriate
conduct on my part that I will be required to withdraw from EDU or ECE classes, at my
own expense, until such time that my record can be cleared or a permanent ruling from the
program coordinator can be rendered.
Signature ________________________________________
Date ____________________________
Mineral Area College
Pre-Service Teacher
MEMORANDUM OF UNDERSTANDING
This Memorandum of Understanding is between Mineral Area College Education Program and the Pre-Service Teacher. The
Pre-Service Teacher acknowledges her/his responsibilities and agrees to the following:
1. The Pre-Service Teacher will abide by all Mineral Area College policies and the public/private school policies
and procedures for which they are completing observations or teaching experiences.
2. The Pre-Service Teacher must successfully pass a criminal background check before being allowed to participate
in any observations or field experience.
3. The Pre-Service Teacher will be under the direction and supervision of the public/private school and the course
instructor. The Pre-Service teacher should be prepared to be asked to perform a variety of everyday teaching tasks
with appropriate preparedness and disposition.
4. The Pre-Service Teacher will maintain an updated timesheet and other documentation required by the instructor
for all their observations and pre-service teaching experience.
5. During pre-service observations and teaching experiences, the Pre-Service Teacher must dress and act
professionally at all times.
6. The Pre-Service Teacher is responsible for his/her own professional liability insurance since it is not provided by
Mineral Area College. Professional organizations include Student-Missouri State Teacher Association (S-MSTA)
and Student-National Education Association (S-NEA). The student may sign a waiver if he/she chooses to decline
this coverage.
7. In case of an absence from pre-service activities, it is the Pre-Service Teacher’s responsibility to contact both the
school and instructor of the course immediately.
8. If the Pre-Service Teacher is not meeting the course or school’s requirements, the Pre-Service Teacher may be
removed from the field experience at the instructor’s or school’s discretion.
I have read the current Education Handbook and the Pre-Service Teacher Memorandum of Understanding and agree to abide
by the stated policies. In addition, I understand that if I do not meet all pre-service teaching requirements, I will not be
allowed to continue in the education program.
The information I have provided on my Education Major application is accurate and true to the best of my knowledge.
Candidate Signature
Candidate Name (Please Print)
Mineral Area College Program Representative Signature
Date
Date
Background Check Application
No payment is required if submitted to the Education Department for processing. Please print legibly and fill out application
completely. Failure to do so will result in the return of the application for correction and will impact the time it takes for processing
Last name
First name
Middle name
Maiden name
Prior names used
Social Security Number
Date of Birth
Gender
Telephone number
Street Address
City
Zip Code
County
By signing below, I agree that all information provided is complete and accurate to the best of my knowledge. I
understand it is unlawful to withhold or falsify information required on this form. I grant permission to Mineral
Area College and the Missouri Department of Health and Senior Services (DHSS) to obtain any and all background
information authorized by law in order to process this request. Furthermore, I authorize the Missouri DHSS to
release the fact that I am a registrant in the Family Care Safety Registry (FCSR) and any related background
information to Mineral Area College. I understand that I do have the right to dispute the information contained
within the FCSR, but must do so within 30 days of receiving results of the background screening determination.
Signature of Applicant (Required in Ink)
Date
All questions should be addressed to the office of Dr. Diana Stuart at 573 518-2252 or via email at Diana@mineralarea.edu
STUDENT RELEASE FORM
Release executed on this _______ day of ______________________, 20_______, by
____________________________________, hereinafter referred to as Releasors, as students of Mineral Area
(student)
College do hereby release, waive, and discharge Mineral Area College of and from all liability, claims or
demand arising out of any participation in observation or off campus activities connected to the Education
Program by said students, as more fully set out below.
In consideration of being permitted to participate in the above referenced activities
sanctioned by Mineral Area College, Releasor, for the personal representatives, heirs and next of kin, hereby
releases, waives, discharges and covenants not to sue on behalf of Releasor Mineral Area College, its officers
and employees, from all liability to Releasor, his/her personal representatives, assigns, heirs and next of kin for
all loss or damage, and any claim or damage therefore, on account of injury to the person or property resulting
in injury or death to Releasor while Releasor is operating his or her own motor vehicle.
Releasor further states that he/she has carefully read the foregoing release and knows the contents
thereof and signs this release as his/her own free act. Releasor further recognizes that he/she is waiving
important substantive rights on behalf of himself/herself.
With full knowledge of the facts and circumstances surrounding this Activity, Releasor voluntarily
undertakes this Activity and assumes all responsibility and risk from my participation in this Activity as stated
above.
Releasor also assures officials of Mineral Area College and the Education Department that I, (Releasor)
have adequate health insurance and other relevant insurance necessary to provide for and pay any medical costs
that may directly or indirectly result from my participation in this Activity and that I will indemnify and hold
Mineral Area College and the Education Department harmless.
In Witness Whereof, Releasor has executed this release at Mineral Area College, Park Hills, Missouri,
the day and year first above written.
____________________________________Releasor/Student