ࡱ>  bjbjߍ 3+Ur r BBBBB4vvvhL*lvG+R+++,a0 m2;F=F=F=F=F=F=F,rI$LiFBu3,,u3u3iF4BB++JG444u3B+B+;F4u3;F44BE;Q/|47EF'F`G0G}EFL4LE4BEdu3u3u3iFiF4u3u3u3GLu3u3u3u3u3u3u3u3u3r :   PURDUE CALUMET APPLICATION FOR STUDENT TEACHING SPRING 2013 Secondary Education Name:  FORMTEXT Last  FORMTEXT First  FORMTEXT Middle Address:  FORMTEXT Street  FORMTEXT City,  FORMTEXT State  FORMTEXT Zip Code Telephone: Home ( FORMTEXT 000)  FORMTEXT 000- FORMTEXT 0000 Work ( FORMTEXT 000)  FORMTEXT 000- FORMTEXT 0000 E-mail Address:  FORMTEXT       Subject Area: Major:  FORMDROPDOWN  If applicable (In Social Studies-list Intense areas here: Academic Experiences A. Other colleges attended/degree(s) earned (if applicable) College Degree  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       B. College honors, awards, and/or activities  FORMTEXT       C. Purdue Academic Advisor  FORMTEXT       D. Grade Point Average (based on 4.0 scale) Education GPA  FORMTEXT 0.00 Cumulative GPA  FORMTEXT 0.00 E. High School Attended  FORMTEXT Name  FORMTEXT City,  FORMTEXT State  FORMTEXT Graduation Date F. College Courses Subject Major Courses Completed Prior to Student Teaching; in Social Studies cite all courses in your three Intense areas Title Course and No. Credit  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       Education Courses Completed Prior to Student Teaching (EDCI AND EDPS) Title Course and No. Credit  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       G. Preferred Placement Level Junior High/Middle School  FORMCHECKBOX  High School  FORMCHECKBOX  Note: You may prefer a particular level, however placement will be made at the discretion/option of the school and/or Coordinating Teacher. Additional Information Talents or abilities you possess that will be an asset to you as a teacher:  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       Volunteer work related to Education:  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       Work experiences related to Education: Employer Job Description Length of Employment  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       Collegiate Field Experiences Completed School Location Grade Level Course Name  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       Classroom Environment Briefly explain your ideal teaching environment. 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FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       I understand the importance of the information I have given in this application and agree to the use of this information by school and university officials in determining my student teaching assignment. Signature ____________________________________________ STUDENT TEACHER QUESTIONNAIRE Name:  FORMTEXT Last,  FORMTEXT First  FORMTEXT Middle Address:  FORMTEXT Street  FORMTEXT City,  FORMTEXT State  FORMTEXT Zip Code Telephone: Home ( FORMTEXT 000)  FORMTEXT 000- FORMTEXT 0000 Work ( FORMTEXT 000)  FORMTEXT 000- FORMTEXT 0000 E-mail:  FORMTEXT       List the School Corporation(s) in which you have relatives attending or currently employed. If you do not have any relatives attending or employed by a School Corporation, indicate this by responding  none . School Corporation  FORMTEXT        FORMTEXT        FORMTEXT       List the School Corporation(s) in which you are employed or have been employed. If you have not been employed by any School Corporation(s), indicate by responding  none . This does not include substitute teaching. School Corporation School  FORMTEXT        FORMTEXT        FORMTEXT       I verify that the above statements are true. I understand that I may not be assigned to the School Corporation(s) listed above. Signed ______________________________________________ Date ______________ STUDENT TEACHING POLICIES AND AGREEMENT Please read these policies carefully and sign this agreement. The agreement must be signed and returned to the Coordinator of Clinical Experiences along with your student teaching application. Applications for SPRING 2013 student teaching must be submitted to X-151 by February 10, 2012. Attendance at your assigned school and at student teacher workshops through Purdue Calumet is mandatory. Excused absences will be granted only for extreme emergencies. Attendance is mandatory at the Student Teaching Orientation to be held on Friday, December, 14, 2012. Failure to attend this orientation may result in the termination of your student teaching semester. Placements for the student teaching assignment will be arranged by the Coordinator of Field Experiences. You do not select your student teaching site. Therefore, you must not call or write corporations on your own initiative. Doing so will jeopardize your placement for student teaching. Placement will not be made in a school district that you have attended or have children, siblings, or other relatives attending or employed. School personnel have a right to interview you before final acceptance for a placement. Once the confirmation agreement is received, placements cannot be changed. If a student needs to change a placement, the student must wait to student teach until the following semester. You must have completed all your education and major area courses before you begin student teaching. This includes all of secondary students primary and supporting areas. You may not take any classes during student teaching unless you have prior approval from the Initial Teacher Preparation Office and the Coordinator of Student Teaching. You must pay or have made payment arrangements for your courses before the date on the Registrar s invoice. You receive this invoice at the time of registration. During student teaching you will follow the calendar of the school to which you are assigned. Student teaching is an uninterrupted length of time (approximately 16 weeks) for an entire teaching day. Dual licensure students will complete two 8-week sessions, one in general education and the other in special education. Purdue University Calumet will set the start and end date when students will officially be expected to begin and complete the student teaching experience. Student teaching is equivalent to having a full-time job. Therefore, students are not allowed to work during the student teaching semester. A $100 fee is required for the student teaching semester. Payment can be made by money order or personal check at the Bursar s Office. You must attach the receipt for this fee to your student teaching application. You are required to contact your Cooperating Teacher to set up an introduction before the official beginning date of student teaching. At this meeting you will supply the school with any needed information and obtain the start date of your student teaching experience. I have read the student teacher policies and I agree to abide by these policies. I understand that a placement will not be made until this form is filed in the Teacher Preparation Office. 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