Teacher Education Handbook - Carson-Newman College

STUDENT TEACHING PLACEMENT FORMAppendix LName ________________________________________________________Student ID ______________Mailing Address ____________________________________________________________________________C-N E-Mail Address __________________________ Primary Phone ______________________ Cell HomeCircle oneDuring what semester and year do you plan to student teach? ____________________________Indicate below the special school district or county in which you would like to student teach. In addition, identify the schoolfrom which you graduated or a school in which you have family members (such as parents, siblings, cousins, etc…) eitheremployed in teaching/administrative positions or attending. You may list two schools per district or county. However, thereare many variables that affect placements, and you may not be able to student teach in the exact setting you identify below.Schools and counties listed must be approved by your adviser by obtaining their signature below.School System/SchoolSchool System/SchoolEarly Childhood(one must be K)Elementary K-6Grades K-3Grades 4-6Middle Grades 4-8:Grades 4-5Grades 6-8Secondary Licensure:Grades 7-8Grades 9-12Specify major/licensure area:K-12 Licensure:Special EducationRegular Classroom: K-5Special EducationArt, Music, Physical Ed, &TESLGrades K-5 (required)Grades 6-8Grades 9-12Name of high school attending and/or where you have relatives attending or working:_____________________________ _________ ____________________________ __________Student Signature Date Adviser Signature Date