DIRECTIONS FOR COMPLETION OF STUDENT TEACHING APPLICATION
PLEASE READ CAREFULLY
For more information on the application process, see
http://www.rider.edu/sites/default/files/docs/edu_ST_Application_PPT.pdf
This student teacher application is very important as it will provide information for placement.
Please use the following checklist to be sure you have submitted the required documents with your
application:
1. Application with all fields filled out and signed verifying that you understand.
2. A resume that highlights your work with youth and your experiences in schools. [For
assistance with this, contact Career Services at http://www.rider.edu/careerservices.]
3. A one to two page philosophy statement that discusses your beliefs about teaching and
learning.
4. A copy of your Examinee Praxis Scores Report. All Elementary candidates must submit this
with your application. Secondary Ed students must submit as soon as you receive scores.
5. Unofficial transcript from MyInfo.
6. A substitute teacher license or criminal background check. [To obtain one, contact the
Administrative Office a School District which may provide you with the paperwork needed. (If
unsuccessful, please indicate this on your application in the field labeled Provide other
considerations, information, etc. The Office of Field Placement will contact you with further
instructions.) You may also contact Damon McWhite at DMcWhite@Source4Teachers.com.]
7. Please be advised that you must have a current Mantoux (TB) test before you will be
permitted to student teach.
Please be advised you CANNOT be an applicant in a district for student teaching if any of the
following circumstances exist: If you have been previously enrolled or graduated from the district,
or if a member of your immediate family or relative is enrolled or employed (in any capacity) in the
district or is serving on the school board in the district.
NOTE: If, before or after receiving confirmation of student teaching assignment, the information
you have stated above changes, you must notify the Office of Field Placement immediately. Failure
to do so will result in removal from assignment upon discovery of conflict of interest and/or
inaccurate information.
The Office of Field Placement is responsible for all placement communication on behalf of the
university. Please make an appointment with the Director or Assistant Director if you have special
circumstances you wish to discuss.
Suzanne R. Gespass, Ph.D.
Director of Field Placement
609-895-5417
gespass@rider.edu
Sue Ellen McConville
Assistant Director of Field Placement
609-895-5612
smcconville@rider.edu
APPLICATION DUE DATE: February 13, 2012
SEMESTER/YEAR*:
Select one: / Select one:
*Semester you plan to student teach
Rider University, Office of Field Placement  Memorial 116  (609) 895-5417
Suzanne Gespass, Director of Field Placement
STUDENT TEACHING APPLICATION (FOR UNDERGRAD STUDENTS)
STUDENT INFORMATION
BRONC ID#:
RESIDENCE DURING STUDENT TEACHING:
HOME
CAMPUS
UNKNOWN
LAST NAME:
FIRST NAME:
CELLPHONE #:
-
(month/year)
MIDDLE INITIAL:
ALTERNATE PHONE #:
-
ANTICIPATED DATE OF GRADUATION:
-
-
MAIDEN NAME (if other than current last name):
ARE YOU INTERESTED IN STUDYING ABROAD:
YES
NO
WOULD LIKE MORE INFORMATION
ADDRESS LINE 1 (STREET NUMBER OR RURAL ROUTE):
ADDRESS LINE 2 (IF APPLICABLE)):
CITY:
STATE:
RIDER EMAIL: (USED FOR ALL PLACEMENT COMMUNICATIONS)
ZIP:
-
ALTERNATE EMAIL:
@rider.edu
DISTRICT AND HIGH SCHOOL ATTENDED:
The Director of Field Placement is responsible for the placement of student teachers. Under no circumstances should you attempt to
make arrangements for student teaching on your own. The information you provide will be among the factors taken into consideration
in making the assignment. You will not be permitted to student teach in your home district or in the school district where your children
attend. The Director will work to place you within a 30 mile radius of the Rider Campus.
ACADEMIC INFORMATION
CUMULATIVE GPA
2ND MAJOR ADVISOR
EDU ADVISOR
INDICATE AREA(S) OF CERTIFICATION FOR WHICH YOU WILL QUALIFY THROUGH RIDER UNIVERSITY
2nd CERTIFICATION
MAJOR* CERTIFICATION
Select one:
Select one:
*If Elementary, your second major in Liberal Arts or Science
PROVIDE OTHER CONSIDERATIONS, INFORMATION, OR SPECIAL CIRCUMSTANCES NEEDED TO HELP THE DIRECTOR PLACE YOU:
3RD CERTIFICATION
ACADEMIC INFORMATION (CONTINUED)
LIST ALL REQUIRED EDUCATION COURSES
(If currently enrolled or plan to enroll, list the appropriate semester/year. Leave grade area blank if you have not yet earned a grade.)
REQUIRED EDUCATION COURSES
COURSE # AND NAME
SEMESTER / YR
GRADE
(if complete)
LIST PREVIOUS FIELD EXPERIENCE
COURSE & SEMESTER
NAME OF SCHOOL / TOWN
GRADE LEVEL
TEACHER
1.
2.
3.
I hereby give my permission for representatives of the Field Placement office to release transcripts, Resume, Belief
Statement, Substitute Teaching License, Criminal Background check to districts and/or school that require this information
for placement purposes.
Have you ever been found in violation by Rider University Student Code of Ethics Conduct?
If yes, please make an appointment to meet with the Field Placement Office.
YES
NO
I have read The Rider University Student Teacher online Handbook and agree to abide by the policies of the School of
Education and the Office of Field Placement. I have read and completed all portions truthfully and to the best of my
knowledge.
Signature of Applicant
Date