Application For Admission To Student Teaching

Submit by November 30th of your junior year.

Name: Name: First Last
EMU ID#:
Cell Phone #:
Full Permanent Address:
Licensure Areas (list all):
Education Advisor:
Content Area Advisor (if applicable)
According to my 4 year plan, I plan to student teach at the following time:
(please select both the term and year)

According to my 4 year plan, I plan to student teach at the following time:
(please select both the term and year) Fall Spring 2024 2025 2026 Other Other
According to my 4 year plan, I plan to graduate at the following time:
(please select both the term and year)

According to my 4 year plan, I plan to graduate at the following time:
(please select both the term and year) December April/May June August 2024 2025 2026 Other Other
Identify your grade level/subject preference for your student teaching placement as listed below according to your licensure area.

Early/Primary Education (PreK-3) - indicate two grade level preferences (PreK-3):
Elementary Education (PreK-6) - you will have one placement in PreK-3, and one placement in 4-6.

Indicate two preferences for PreK-3 grade level, and two preferences for grades 4-6:
Secondary Education (6-12) - you will have one placement in middle school and one placement in high school.

Indicate 6-8 subject(s) and/or grade you wish to teach:
Secondary Education (6-12) - you will have one placement in middle school and one placement in high school.

Indicate 9-12 subject(s) and/or grade you wish to teach:
All Grade Education Licensure (PreK-12) - you will have one placement in an elementary school and one in either a middle or a high school.

Indicate which level you prefer:
Middle School (6-8)
High School (9-12)

All Grade Education Licensure (PreK-12) - you will have one placement in an elementary school and one in either a middle or a high school.

Indicate which level you prefer:
Middle School (6-8)
High School (9-12) Middle School (6-8) High School (9-12)
Sign below to verify the following:

1) Have you ever been convicted of any felony or of a misdemeanor involving children or drugs?

Sign below to verify the following:

1) Have you ever been convicted of any felony or of a misdemeanor involving children or drugs? Yes No
2) I waive my right to view the information provided by my references.

Draw or Type

Clear

Full Name
Date: Date: / MM / DD YYYY
The student teaching semester includes two student teaching placements and the course ED 411 Reflective Teaching Seminar. Student teaching takes precedence over all other activities for the semester and is to be seen as a fulltime, full load program.
Additional coursework, work (work study or any other job), and intercollegiate athletic involvement are strongly discouraged.

Do you have any concerns supporting this policy?

The student teaching semester includes two student teaching placements and the course ED 411 Reflective Teaching Seminar. Student teaching takes precedence over all other activities for the semester and is to be seen as a fulltime, full load program.
Additional coursework, work (work study or any other job), and intercollegiate athletic involvement are strongly discouraged.

Do you have any concerns supporting this policy? Yes No
If Yes, indicate what item concerns you:

If your answer was yes, bring your concern to your student teaching meeting with the Coordinator of Field Placement. Written permission is required for coursework, work (work study or other job), and participation on a varsity team. Refer to the "Program Policies for Student Teaching" section of the Teacher Education Handbook (in myEMU) for further details on the policies related to additional coursework, work, and athletic involvement.

If Yes, indicate what item concerns you:

If your answer was yes, bring your concern to your student teaching meeting with the Coordinator of Field Placement. Written permission is required for coursework, work (work study or other job), and participation on a varsity team. Refer to the "Program Policies for Student Teaching" section of the Teacher Education Handbook (in myEMU) for further details on the policies related to additional coursework, work, and athletic involvement. Coursework Work (work study or any other jobs) Athletic involvement
Transportation to student teaching is the sole responsibility of the student.

Are you a licensed driver?

Transportation to student teaching is the sole responsibility of the student.

Are you a licensed driver? Yes No
Will you have a car available during your period of student teaching?

Will you have a car available during your period of student teaching? Yes No