HOPE COLLEGE
EDUCATION DEPARTMENT

STUDENT TEACHING APPLICATION
Last Name:

First Name:

Middle/Maiden:

Anticipated Date of Graduation:

Birthdate (month/day/year)
Local Address:
 Phone #:
Email Address: (Required)
Student #:
   
A. Indicate when you will be taking your Senior Seminar course (a general education requirement):
Senior Seminar: Fall
Spring
May/June/July 		Year
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 Spring
Fall
2. Elementary:
RANK IN ORDER OF PREFERENCE:
Kindergarten
Lower
Upper
Middle School
Special Education:
Elementary
Middle School
High School
Secondary:
Middle School
Sr. High
K-12 (PE, Music, Visual Arts & Dance):
Middle School/Elementary
High School/Elementary
C. Major 1
 Minor 1
Major 2
 Minor 2
D. Field Placements
1. Give evidence of a field placement that represents a culturally diverse or multicultural
(20% or more schoolwide) experience.
School
 Grade Level


Date of Placement
2.

Have you had a field placement experience in a general education setting at the levels listed below?

Elementary Yes No
Middle School Yes No
High School Yes No
3.

FOR SPECIAL EDUCATION MAJORS ONLY:  Have you had a field placement experience in a special education setting at the levels listed below?

Elementary Yes No
Middle School Yes No
High School Yes No

 
E. Will you have transportation available?
Yes
No
F. High School attended:
G.

School preference:
RANK IN ORDER OF PREFERENCE:
Public
Private
Charter
No Preference

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:
  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?
I. Have you ever been convicted of or pled no contest to a misdemeanor or felony?
Yes
No
Do you currently have any charges pending?
Yes
No
  (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.

K. Comments:
Failure to apply by the designated deadline will result in a $100.00 late fee charged to your student account.