Check the one that applies to you:
Student Teaching_____
THECB Educational Aide Exemption
(State Approval Exemption Letter on file in Department)_____
Department of Urban Education
Application for Professional Development Semester 3
Submit two paper copies of this application and two paper Criminal History Forms to the
Teacher Education Coordinator by the deadline given at the PD 3 Information Meeting.
Personal Information (Please Type)
UHD Site(Circle One) : UHD
Cy-Fair
TEA Number:__________________
Northwest
Kingwood
Name:_________________________________ UH-D Identification Number:______________
Address:______________________________________________________________________
Street
City
Phone:________________________________
State
Zip Code
________________________________
Home
Cell
E-Mail:________________________________
Personal
________________________________
UH-D E-Mail Address
Assignment Preference
The following School Districts are members of the Department of Urban Education Center for the Professional
Development of Teachers (CPDT). You can select from these school districts only.
Aldine
Alief
CyFair
Fort
Bend
Galena
Park
Houston
Humble
Klein
Spring
Branch
Stafford
Preferences are given consideration and placements will be based on availability of approved Cooperating Teachers
through the Participating School Districts. Please do not contact the school district or school until you have
received an official notice of your assignment. The University of Houston-Downtown Department of Urban
Education reserves the right to place all student teachers in the best possible student teaching assignment available.
Type your 1st and 2nd PREFERRED SCHOOL DISTRICT CHOICES.
1st District Choice:________________________________________________
2nd District Choice:________________________________________________
Preferred Grade Level Placement:_____________________
Revised Spring 2012
Check the one that applies to you:
Student Teaching_____
THECB Educational Aide Exemption
(State Approval Exemption Letter on file in Department)_____
Department of Urban Education
Professional Development Semester 3 Student Teaching Agreement
(Submit even if plan to be Exempt from Student Teaching)
I am aware that the Student Teaching experience is governed by the policies of the Department of Urban
Education and the PD 3 Student Teaching Handbook. I understand that my responsibility is to follow and
meet the expectations in the handbook regarding professionalism, schedules, evaluations, absences,
schedule changes, and other student teaching requirements.
I UNDERSTAND THAT IF ALL REQUIREMENTS FOR PD 2 ARE NOT COMPLETED BY THE END
OF THE SEMESTER PRECEDING PD 3, MY STUDENT TEACHING ASSIGNMENT WILL BE
CANCELLED. THOSE REQUIREMENTS ARE:






Formal Admission in the Teacher Education Preparation Program
Successful completion of PD 1 and PD 2
Cumulative GPA of 2.5
Cumulative GPA of 2.5 in the area of specialization
Formal Registration for PD 3
Any Additional Requirements listed in the PD 3 Student Teaching Handbook
I UNDERSTAND THAT ATTENDING THE SCHEDULED STUDENT TEACHING ORIENTATION
MEETING AND PD 3 INFORMATION MEETING IS MANDATORY. THE APPLICATION DEADLINE
MUST BE MET TO OBTAIN A STUDENT TEACHING ASSIGNMENT AND TO ENSURE A
SUCCESSFUL STUDENT TEACHING EXPERIENCE. I UNDERSTAND THAT MY PD 3 STUDENT
TEACHING ASSIGNMENT WILL BE CANCELLED IF THE ABOVE CRITERIA ARE NOT MET.
If for any reason I am unable to complete or need to postpone the student teaching assignment and cannot
meet the student teaching requirements, I will notify the Teacher Education Coordinator, UH-D Field
Supervisor, and the Cooperating Teacher immediately. I will notify the Teacher Education Coordinator
immediately of any change in my name and personal information or academic status.
A consideration in our partnership with the CPDT School Districts is the safety of their children. Formal
Criminal History Background Checks must be completed and submitted with the PD 3 Application and
will be processed by the school district. I understand the school district may request additional
information and/or an individual conference prior to assignment of a student teaching placement.
I understand that additional personal identification information may be required for me to submit directly
to the school district office or personnel, depending upon assignment, copies that may include but are not
limited to the following: social security number; Texas driver’s license.
I certify that I will comply with the expectations indicated in this agreement, in the PD 3 Student Teacher
Handbook, and of the Department of Urban Education teacher preparation program. I acknowledge that
all of the information on this application is correct.
Signature___________________________________
Full Name Typed___________________________________
Revised Spring 2012
Date _____________________________
Check the one that applies to you:
Student Teaching_____
THECB Educational Aide Exemption
(State Approval Exemption Letter on file in Department)_____
Personal Information (Please Type)
UHD Site(Circle One) : UHD
Cy-Fair
Northwest
TEA Number:__________________
Kingwood
Name:_________________________________ UH-D Identification Number:______________
Academic Information
Certification Area: EC-6 Generalist_____
4-8 Generalsit _____
EC-6 Bilingual Generalist_____
8-12 Secondary
_____
Secondary Content Area ____________
Expected Date of Completion:
May_____
Dec._____
Aug._____
List courses in which you are currently enrolled:
Course Number
Course Title
Course Number
Course Title
______________
__________
______________
___________
______________
__________
______________
___________
______________
__________
______________
___________
Year________
At the end of the current semester, which courses will you still lack (other than PD 3)?
When do you plan to take the course(s)?
Course Number Semester to be Taken
Course Number
Semester to be Taken
______________ __________________
______________
___________________
Criminal History Background Forms – Submit one form for each school district preference
(two forms) with the PD 3 Application.
Submit Completed Application, signed Student Teaching Agreement, and two Criminal
History Forms to:
Lisa Hill
Teacher Education Coordinator
Department of Urban Education
University of Houston-Downtown
One Main Street
C440-M Commerce Building
Houston, Texas 77002-1001
Revised Spring 2012