OTTERBEIN UNIVERSITY STUDENT TEACHING PREFERENCE FORM PART 2
Semester/Year
(Choose One)
Select Program:
Fall Semester 2015
Spring Semester 2016
Fall Semester 2016
Spring Semester 2017
Fall Semester 2017
Spring Semester 2018
Local Placement
Alternate Experience
Special Request
NAME
DATE OF APPLICATION
February 9, 2016
Program Major/Concentration Areas and Coursework
MAT Intervention
Early Childhood
Middle Childhood
Specialist
MAT Middle
AYA (Grades 7-12)
Multi-Age (Grades PK-12)
Childhood
EDUC 5970 Student
EDUC 4710 Student
EDUC 4810 MCHD
EDUC 5970 Student
EDUC 4100 AYA/Multi-Age Student Teaching
Teaching
Teaching
Student Teaching
Teaching
EDUC 4110 SYE Seminar
EDUC 4720 SYE
EDUC 4820 SYE Seminar
Seminar
Mild to
Early
Moderate
Middle Childhood (4-9)*
Childhood (PK-3)
Moderate to
ECIS
Intensive
Int. Lang Arts
Health Education
Int. Mathematics
Music Education
Int. Soc. Studies
Physical Education
Foreign Language
Concentration 1
Concentration 2
Lang Arts
Lang Arts
Life Sciences
Mathematics
Mathematics
Phys. Sciences
Science
Chemistry
Soc. Studies
Physics
E.C. 4-5
Generalist
Science
Soc. Studies
Language:
Visual Art
*Middle Childhood majors are required to do their methods in one area of concentration and their student teaching in the second area of concentration. *Note: if you have not yet
completed Methods, be sure to inform your methods instructor that you need to do your method’s field experience in your other area of concentration. If this placement changes, alert the
Student Teacher Placement Director immediately! If you are a MCHD major, list the concentration area you did your methods placement in here:
LOCAL ADDRESS
HOME ADDRESS
LOCAL PHONE
HOME PHONE
E-MAIL ADDRESS
E-MAIL ADDRESS
I WILL BE COMMUTING FROM:
Otterbein University
Other, list:
My grade level preference (from most to least preferred)
First Choice
Do you have any additional preferences (district, school, teachers)?
Student Teaching Placement Form
MMF 2015
Second Choice
Third Choice
Explain why you are making this request:
Please check the following, I understand that…
I could be placed in one of several districts, depending on available
placements and supervisors’ loads
I should not be placed where I attended school or where a family
member is employed, or a child attends. (Please list below any schools
or districts where you have connections that we should avoid:
District/Schools to avoid placement:
**Students are placed in school districts that have contracted with Otterbein University Education Department to receive field experience students. Placements are based on locations and
numbers of schools and teachers at needed subject and grade levels, the agreement from administrators to receive students, and the availability of university supervisors. Students need
the opportunity to demonstrate competency in an unbiased setting. Student teachers will not be placed in schools from which they graduated, where they have held employment, where
they have children in school or where they have close friends or relatives as students or employees. Under no circumstances are students to arrange their own placements or contact the
school district office. Securing a placement can sometimes be a complicated and time-consuming undertaking. It involves many people other than you and the Education department.
Many other colleges and universities in the area are also requesting student teaching placements. Additionally, no school is required to take a student teacher. Please be patient. While
your special request will be considered, Otterbein cannot guarantee that your request will be fulfilled.
Additional comments or additional information you would like considered regarding placement:
This form is for Department Use Only it will not be shared with school districts.
Student Teaching Placement Form
MMF 2015