HOPE COLLEGE
EDUCATION DEPARTMENT
STUDENT TEACHING APPLICATION |
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Last Name:
First Name:
Middle/Maiden:
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Anticipated Date of Graduation:
Birthdate (month/day/year)
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Local Address:
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Phone #:
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Email Address: (Required)
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Student #:
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| A. |
Indicate when you will be taking your Senior Seminar course (a general education requirement): |
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Senior Seminar: |
Fall
Spring
May/June/July |
Year
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NOTE: All special education majors will take the 6-hour special education sequence during the fall semester and complete Senior Seminar (and Perspectives in Education) in the spring semester. |
| B. |
Student Teaching Assignment
Requested: |
| 1. |
Year
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Spring
Fall |
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| 2. |
Elementary:
RANK IN ORDER OF PREFERENCE:
Kindergarten
Lower
Upper
Middle School |
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Special Education:
Elementary
Middle School
High School |
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Secondary:
Middle School
Sr. High |
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K-12 (PE, Music, Visual Arts & Dance):
Middle School/Elementary
High School/Elementary |
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| C. |
Major 1
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Minor 1
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Major 2
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Minor 2
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| D. |
Field Placements |
| 1. |
Give evidence of a field placement that represents a culturally diverse or multicultural
(20% or more schoolwide) experience. |
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School
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Grade Level
Date of Placement
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| 2. |
Have you had a field placement experience in a general education setting at the levels listed below?
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| 3. |
FOR SPECIAL EDUCATION MAJORS ONLY: Have you had a field placement experience in a special education setting at the levels listed below?
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| E. |
Will you have transportation available?
Yes
No |
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| F. |
High School attended:
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| G. |
School preference:
RANK IN ORDER OF PREFERENCE:
Public
Private
Charter
No Preference |
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| H. |
Will you be employed or participating in a music program, on a sports team, or in any other organization or activity at (or outside of) Hope College during your student teaching semester?
Yes
No
If yes, which program/employment/activity:
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Will your employment or participation in the above program/organization/activity require you to be absent from your student teaching placement?
Yes
No
If yes, how many days will you be absent from the classroom?
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| I. |
Have you ever been convicted
of or pled no contest to a misdemeanor or felony?
Yes
No |
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Do you currently have any charges pending?
Yes
No |
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(If you answered yes to either question above, please make an appointment to see the Director of Certification if you have not already done so.) |
| J. |
Requests:
If you are interested in teaching in a particular geographical area, school, or with
a specific teacher, please identify below. Requests for off-campus placements must
be approved in advance by the department.
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| K. |
Comments:
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Failure to apply by the designated deadline will result in a $100.00 late fee charged to your student account. |
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