APPLICATION FOR STUDENT TEACHING - EBD Licensure Candidates

Program: DAY_____ WEC _____

Name __________________________________________ I.D.# ___________________ Date_________

Present Address ___________________________________________________ e-mail ______________

City, State, Zip _______________________________________________________________________

Home Phone __________________________ Work Phone __________________________

Teaching Major: _______________________________

Current Position ___________________________________________________________

Current License ____________________________________________________________

Multicultural Education Program Yes________ No _________ District____________________________

I. REQUIREMENTS PREREQUISITE TO STUDENT TEACHING:

A. Acceptance into the Education Department Licensure Program

1. Have you been accepted in the Education Department? Yes______ No_____

2. Do you have a minimum 2.5 GPA in your major and Education courses? Yes_____ No_____

3. Do you have a minimum 2.5 GPA in your major? Yes _____ No _____

4. Do you have a minimum 2.5 cum GPA for all coursework? Yes_____ No_____

5. Are any of your required courses in Educ. or your major below 2.0? Yes _____ No _____

6. Have you passed all portions of the PPST? Yes _____ No _____

B. Completion of the prerequisite courses: (See list of courses later in this application)

1. Have you completed your general education courses? Yes _____ No _____

2. Will you complete all requirements for graduation by end of this term? Yes _____ No _____

II. List the Clinical/Fieldwork/Classroom Experiences already completed:

School District Grade Subject

___________________ __________________ __________ _________________

Please list any clinical coursework (providing the same information required above) you are taking this semester (or will complete before you plan to student teach:

____________________ ___________________ _________ __________________

NOTE: It is the student’s responsibility to inform the Director of Teacher Placement immediately if you fail to complete current coursework for any reason.

PLACEMENT INFORMATION

Your Name: __________________________________________________________________________

Placement/Work Site: ___________________________________________________________________

Address: ____________________________________________________________________________

City, St, Zip:___________________________________________________________________________

District:______________________________________________________________________________

Principal:_____________________________________________________________________________

Mentor Teacher:____________________________________ Grade Level:_________________________

Dates of Student Teaching:_______________________________________________________________

Courses of Student Teaching Needed: ______________________________________________________

List Remaining Licensure Courses Needed:

AUGSBURG STUDENT TEACHING - SIGNATURE PAGE & MISC. INFO.

IV. Student Teaching Registration

The required number of student teaching courses varies with individual requirements. Most Special Education student teachers need to register for 2 courses. If a candidate already holds a license, one to two courses may be required, depending on the licensure area and experience. Your Special Education Advisor will help you determine the correct number of courses required for your situation.

Courses in Student Teaching:

K-12 Licensure -

Elementary SPE 481A SPE 483A Secondary SPE 485A SPE 487A

This application CANNOT be accepted without your Education Department faculty advisor’s signature and your signature. The Education Department advisor’s signature below indicates that the advisor has reviewed this application with the student for student teaching prerequisites. It is the student’s responsibility to represent their coursework/program and grades accurately. The student’s signature indicates that all coursework and grades listed in this application are accurate and true.

___________________________________________ Date__________

Augsburg College Education Department Faculty Signature

___________________________________________ Date__________

Student Signature

AUTHORIZATION BY STUDENT FOR RELEASE OF TRANSCRIPT(S)

I, the undersigned, hereby authorize the Augsburg College Education Department Chairperson and/or field placement coordinator to forward a copy of my transcript(s) for all courses completed at Augsburg College and/or elsewhere to any school district which might require this record as a prerequisite for consideration of student teaching placement.

___________________________________________ Date__________

Student Signature

PLEASE NOTE: IMPORTANT INFORMATION !

• The remaining parts of the application will be sent to the school district(s) where your placement is requested.

• It will be seen by principals and teachers.

• It represents YOU! This form is used to tell the principals/teachers about you. Fill it out in such a way that it describes who

you are and those experiences you have had which will make you a good student teacher.

• Please see that it is thoughtfully filled out and word processed. Make sure that you copy each question and then provide

an answer, just as this form models. These pages will be carefully duplicated on white paper, so most corrections you

make will not how on the copies. The original will be kept in the Education Office.

The Augsburg Education Department commits itself to developing future educational leaders

Who foster student learning by being knowledgeable in their fields,

Being capable in pedagogy, being ethical in practice, nurturing self-worth,

Embracing diversity, thinking reflectively and collaborating effectively.

STUDENT TEACHER EDUCATIONAL BACKGROUND

Name _____________________________________________________ Date ___________________________

Local Address _______________________________________________________________________________

City, State, Zip_________________________________________________ Phone ________________________

Degree Earned:________________________________________________

K-12 LICENSURE COURSES REQUIRED Where/When Taken Grade_________

HPE 115 Chemical Dependency ________________________________ ____________

ENG 111 Effective Writing ________________________________ ____________

INS 105, or Intro American Ind. Studies

INS 260 Contemporary Am. Indians ________________________________ ____________

EDC 206/566 Diversity/MN Am. Studies ________________________________ ____________

EDC 200/522 Orientation to Education ________________________________ ____________

EDC 210 or Diversity in the Schools ________________________________ ____________

EDC 206/566

EDC 220 Educational Technology ________________________________ ____________

EDC 310 Learning & Development ________________________________ ____________

SPE 315 Critical Issues Seminar ________________________________ ____________

EDC 320 K-8 Methods: Reading ________________________________ ____________

EED 330 K-6 Methods: L.Arts/Child Lit ________________________________ ____________

EED 350 K-8 Methods: Math ________________________________ ____________

EED 360 K-6 Methods: Science ________________________________ ____________

EDC 410 Special NeedsLearner ________________________________ ____________

SPE 400 Teach.Students w/EBD ________________________________ ____________

SPE 410 Implem. Asses. & Strategies ________________________________ ____________

SPE 420 Planning, Design & Delivery ________________________________ ____________

SPE 430 Instruct. & Behav. Practices ________________________________ ____________

SPE 440 Parent & Profess. Planning ________________________________ ____________

AUGSBURG COLLEGE – STUDENT TEACHER MAJOR PROGRAM COURSES

List all coursework supporting your Major and Minor:

WHERE/WHEN

COURSE NUMBER & TITLE TAKEN GRADE

______________________________ ____________________ ____________

______________________________ _____________________ ____________

______________________________ ____________________ ____________

______________________________ _____________________ ____________

______________________________ ____________________ ____________

______________________________ _____________________ ____________

______________________________ ____________________ ____________

Augsburg College - Student Teacher Biographical Essays

Directions: Please word process your responses to the following questions. Type each question as it appears below, following each question with your response. Your responses should generate 2-3 pages; no more than 3 pages please! Remember that this is the only representation of yourself that is sent to the school where your placement is being requested. Let these represent you well!

Name: _________________________________________________ Date: _________________________

1. What goals and/or expectations have you established for your student teaching experience? Consider discussing any or all of the following:

• What you most want to learn from your student teaching experience;

• Teaching techniques/methods you have had some experience with and would like to use during your student

teaching, e.g. cooperative learning, direct instruction, inquiry learning, concept learning, authentic

assessment, etc.

• Teaching techniques/methods you are currently least skillful with and would like to develop further

during student teaching

2. Briefly describe experiences (paid/volunteer) you have had working directly with young people/children. Include previous field/classroom experience connected with teacher education coursework.

3. Briefly describe experiences related to assessment and due process.