PLACEMENT REQUEST FOR STUDENT TEACHING
Name:
Semester:
Year:
Local Address:
Local Phone:
Other Phone:
Email:
Student ID ___________________________
Date of Birth ____________________________
Private or Parochial School Student Teaching Placement:
yes_____
no_____
if needed_____
Please indicate if you have NO transportation _________ (please check)
Provide school, grade level and/or subject area for the following completed field
ELEMENTARY
experiences
SECONDARY
EDTE 221L _____________________________________EDTE 221L __________________________________
EDTE 301______________________________________ EDTE 440L __________________________________
EDTE 401L _____________________________________EDTE 454L__________________________________
M.I.T.
EDTE 505 _______________________________________EDTE 506 __________________________________
EDTE 507 _____________________________________
Choices available:
Elementary Student Teachers:
Secondary Student Teachers:
Rank order your placement choices.
Rank order your placement choices.
School and/or teacher
content area(s):
1st:
_____ high school
2nd:
School and/or teacher
grade level choice:
1st:
K-3
4-6
__________________________
_____ middle school
1st:
2nd:
2nd:
PLEASE INDICATE IF YOU HAVE A PLACEMENT THAT I CAN CONFIRM
School
Teacher
Grade
Additional information that I needed to know regarding your student teaching placement
SPOKANE, WASHINGTON 99258-0025 (509) 313-3516