Student Teaching Application - Early Childhood Program | College of Education

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I am applying for *

Spring 2025

Fall 2025

Last Name *

First Name *

Middle Initial

Present cohort site *

Phone *

UA Student ID *

Local Address (Apt. No) *

City/State/Zip *

Permanent Address (Apt No)

Permanent City/State/Zip

UA Email *

Alternative Email

Have you ever been convicted or pled “No Contest” for any violation of the law other than minor traffic violations? *

Yes

Race/Ethnicity

Current Semester Status *

Undergraduate

Post-Baccalaureate

Are you an international student? *

Yes

Seniors, please identify your preschool and elementary placement sites & mentors. Juniors identify your current site & mentor

Please enter the name of the school, grade level and the name of the teacher with which you were placed.

In the event that a previous practicum placement is not available as a student teaching placement, we would like to know your preferences. Please describe below any district, school or teacher placement you may prefer and why.

	1	2	3
K	K - 1	K - 2	K - 3
1st	1st - 1	1st - 2	1st - 3
2nd	2nd - 1	2nd - 2	2nd - 3

Student Teaching Placement Policy

I understand it is against University policy to be placed for student teaching where my children attend school or relatives are employed. Exceptions to this policy need to be approved by the Director in charge of placements. *

Yes

Permission for Release of Information

School Districts frequently request student information for student teaching placements and job opportunities. This may include, but is not limited to name, address, phone number, email, student teaching packet information, and unofficial transcripts.This may include name, email, and type of certification program. If an employer requests other information, you would be contacted for permission. *

I authorize the Director of Student Services and/or the Director of Field Experiences to release the above information for placement and job opportunities.

I DO NOT authorize the Director of Student Services and/or the Director of Field Experiences to release the above information for placement and job opportunities.

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