Application For Student Teaching: Fall 2015 and Spring 2016
All applications must be personally HAND-delivered to personnel in the
Teacher Education Office, Boyle Hall 225 – by 4:30 P.M. on MONDAY,
December 1, 2014 -- DO NOT DROP OFF AFTER HOURS!
FOR OFFICE USE ONLY:
PLEASE CHECK WHICH SEMESTER FOR STUDENT TEACHING:
_____ Fall 2015
_____Spring 2016
___ $10.00 Background check fee included (Separate check payable to: St. Norbert College)
OVERSEAS APPLICANTS ONLY:
___ $300.00 Application Fee included (Separate check payable to: St. Norbert College)
___ Application Signed
Received by: ____________________________________Date Received_____________________________
Notes:
Application For Student Teaching
Before completing this application, please read the requirements for approval to student teach including
those regarding transportation for student teaching placements listed on the Teacher Education website at:
http://www.snc.edu/education/program/studentteaching/requirements.html
http://www.snc.edu/education/program/studentteaching/placement.html
I HAVE READ AND AGREED TO THESE REQUIREMENTS AND CONDITIONS AND UNDERSTAND THEM.
I affirm the accuracy of all information in this application and understand this information will be used by Teacher
Education Faculty in securing a student teaching placement. Also, I hereby authorize the Teacher Education Discipline
to release included information as well as results from criminal background checks to those schools and/or school
districts that require this information for my placement. I understand that student teaching is an entire semester, full
days, according to the public /private school calendar where I am placed. I am no longer on SNC’s calendar.
_______________________________________________
__________________
Student Signature
Date
First Name &
Middle Initial
Last Name
Local Address
Permanent Address
City, State, Zip
City, State, Zip
Campus Telephone
Home Telephone
High School Graduated
SNC E-mail
Any Area Schools Where
Relatives Attend/Work
1
Application For Student Teaching: Fall 2015 and Spring 2016
All applications must be personally HAND-delivered to personnel in the
Teacher Education Office, Boyle Hall 225 – by 4:30 P.M. on MONDAY,
December 1, 2014 -- DO NOT DROP OFF AFTER HOURS!
Select your certification program:
Early Childhood-Middle Childhood (formerly Early Childhood/Elementary)
Middle Childhood-Early Adolescence (formerly Elementary/Middle)
Early Adolescence-Adolescence (formerly Middle/Secondary)
MUSIC (Early Childhood-Adolescence)
General (K-12)
Instrumental (K-12)
Choral (6-12)
Certification Major(s) or Minor(s):
Student Teaching Requirements
Please check all requirements that have been successfully met and include necessary information. Also, please
understand that if all requirements have not been successfully met, your application cannot be processed.
Successfully Completed the PPST:
Reading (Scored 175 or above)
Writing (Scored 174 or above)
Mathematics (Scored 173 or above)
Number of Documented Human Relation Hours:
Hours Part A (min. of 18 required)
Hours Part B (min. of 18 required)
Please check the GPA requirements that have been successfully met.
3.0 in Major
3.0 in Minor
3.0 in Professional Education Courses
2.75 Overall
Please note:
For fall student teaching, GPA requirements must be met by December 12, 2014.
For spring student teaching, GPA requirements must be met by September 1, 2015.
Praxis II (Content Area Examinations)- MUST RECEIVE PASSING SCORE PRIOR TO STUDENT TEACHING PLACEMENT*
Please check the testing date for which you have taken or for which you plan to register:
Taken
Month
Year
Scheduled
Month
Year
*Fall student teachers must pass the Praxis II no later than January prior to expected student teaching
semester. Spring student teachers must pass Praxis II no later than August prior to expected student
teaching semester.
2
Application For Student Teaching: Fall 2015 and Spring 2016
All applications must be personally HAND-delivered to personnel in the
Teacher Education Office, Boyle Hall 225 – by 4:30 P.M. on MONDAY,
December 1, 2014 -- DO NOT DROP OFF AFTER HOURS!
Placement Information
Information below will be used in securing your student teaching placement.
Where did you complete your Block practicum (EDUC 249 or EDUC 250)?
School:
Grade:
Do you participate in an intercollegiate sport at St. Norbert College?
Yes
No
If so, which sport?
In what season does the sport take place:
Fall
Spring
Approximate length of sport (example: August – December)
Do you plan on graduating in December 2015? Yes
In which semester do you prefer to student teach ?
month -
month
No
Fall
Spring
Please understand that every effort is made to accommodate student requests regarding the semester in
which they student teach. However, Teacher Education Faculty reserves the authority to make final
decisions on student teaching placements. If the number of applicants for a particular semester exceeds the
allotted number of available placements, a lottery will be used to determine placements.
If there is an academic reason why you need to student teach in a particular semester, please explain
circumstances in detail below. For example, if you need to take a specific course (or courses) during a
specific semester, please explain the situation and include the appropriate course number(s).
3
Application For Student Teaching: Fall 2015 and Spring 2016
All applications must be personally HAND-delivered to personnel in the
Teacher Education Office, Boyle Hall 225 – by 4:30 P.M. on MONDAY,
December 1, 2014 -- DO NOT DROP OFF AFTER HOURS!
CRIMINAL BACKGROUND CHECK
RELEASE FORM
I understand that prior to student teaching the Placement Coordinator will perform a Criminal
Background Check through the National Criminal Record Search, the National Sex Offenders Registry, and
the Social Security Verification.
PLEASE CONTINUE ONLY IF YOU INTEND TO STUDENT TEACH OVERSEAS
(Applying to student teach overseas requires a non-refundable $300 processing and placement fee)
4
Application For Student Teaching: Fall 2015 and Spring 2016
All applications must be personally HAND-delivered to personnel in the
Teacher Education Office, Boyle Hall 225 – by 4:30 P.M. on MONDAY,
December 1, 2014 -- DO NOT DROP OFF AFTER HOURS!
Country Desired: Please select 3 and indicate order of preference
Costa Rica (limited availability)
England
Ghana
Ireland
Japan
New Zealand (fall semester only)
St. Lucia
Scotland
Other (must be approved by Teacher Education Discipline)
If no confirmation is received from the partner school five months prior to the departure
date, there is no guarantee of an overseas placement at the discretion of the discipline.
Unique Requests:
Age Group Desired:
4-6(infants)
Mother’s Name (full):
Work Phone:
Street Address:
Home Telephone:
E-mail:
City
State
Zip
Father’s Name (full):
Work Phone:
Street Address:
Home Telephone:
E-mail:
City
State
Zip
Are you in good health?
Yes
Do you smoke?
No
Any allergies?
Yes
Yes
7-9 (lower primary)
No
No
If yes, please describe in detail:
Health Insurance Carrier:
Policy Number:
On file with the College?
Passport or Visa Number:
Yes
No
5
10-11 (upper primary)
12-18 (secondary)