School of Education
School Experience Preferences
Please refer to accompanying ‘Notes for School Experience’ before completing the following:
Title
Click here to enter text.
Forename(s)
Click here to enter text.
Surname
Click here to enter text.
Teaching subject
Click here to enter text.
(If you are taking modern languages please specify them as separate subjects (e.g. French, Irish, Spanish etc.).
Home base location school experience 1 (i.e. South Belfast, Armagh etc.)
Click here to enter text.
Home base location school experience 2 (i.e. South Belfast, Armagh etc.)
Click here to enter text.
Secondary school(s) attended as a pupil
Click here to enter text.
School(s) not to be approached because of presence of near relative
Click here to enter text.
Please indicate three schools for each school experience which are easily accessible from your residence
address (do not include secondary schools attended as a pupil). Note that these are for guidance purposes only
and we cannot guarantee a placement at any of the schools chosen.
11-16 schools (normally secondary & integrated schools. Some secondary schools will cater up to age 18 and may be
included here)
Click here to enter text.
Click here to enter text.
Click here to enter text.
11-18 schools (normally grammar/integrated & some secondary schools who cater up to age 18)
Click here to enter text.
Click here to enter text.
Click here to enter text.
Will you have access to a car for travelling during school placement?
Choose an item.
Special factors you wish to be taken into consideration
Click here to enter text.
Sometimes placement schools want to contact placement students directly by email. Do you agree to the School of
Education disclosing your QUB email address to a placement school?
Choose an item.
Once you have completed this form, please print it out and return to the Initial Teacher Education Secretary (within two
weeks of the date on the offer letter) with:
 Access NI Enhanced Disclosure
 Health Declaration Questionnaire