School of Education, Health and Human Behavior


Applications are due in School of Education, Health and Human Behavior Student Services Office (1st floor, Founders Hall, Room 1110) by Friday, January 30, 2015

PLACEMENT NOTE:  All CI 315a students will have two 8 week placements.  One placement will be in a middle school and one placement will be in high school.

Application process Ė

1.       Enter the information on the screen and submit.

2.       Print off the Authorization of Eligibility form that will appear once you hit submit.  Bring this form to your major advisor for signature.

3.       Print off the Student Profile Sheet instructions and prepare your student profile. 

4.       Both the signed Authorization of Eligibility and Student Profile Sheet should be returned to School of Education, Health and Human Behavior Student Services Office by the stated deadline.

5.       Print off the CI 315A field experience requirements and complete as required.

A. Please select your program of study below:

1. General Information
(Please include area code)
(Please include area code)

2. Will you be living at the above address during this placement?

3. If no, list campus address if different from above address:

4. School attended (include city and state)

5. Have you taken and passed the Test of Academic Proficiency Test (TAP) or completed the paperwork to use an ACT score in lieu of the TAP?

5a. If not, please list date you are registered to take the test
Students are not allowed to proceed in CI 315A if they have not passed the TAP Test.

6. Will you have the middle school endorsement courses completed by the end of your student teaching semester?

7. CONFLICT OF INTEREST: Candidates are placed in schools for field experiences and student teaching within a 40 mile radius of the University; however, candidates may not be placed in schools in which they have a potential conflict of interest.  Conflicts to be avoided are schools in which the candidate has attended, has relatives employed or attending or has any other potential conflicts that may impact his or her placement at the school.  Please list any schools within a 40 mile radius of SIUE in which you may have a potential conflict of interest and the type of conflict. 

8. HARDSHIPS: Please list any schools/districts/areas within a 40 mile radius of SIUE that would pose a hardship and the type of hardship.  Hardships might be driving distance from your home, schools that do not have special accommodations to meet your needs, distance from daycare, etc.  School of Education, Health and Human Behavior Student Services Office cannot guarantee you will not be placed in any schools listed,  but we will work to best accommodate your needs within the program parameters in seeking a field placement.  Please take notice that School of Education, Health and Human Behavior Student Services Office will not make changes after placements are established. 

9. At which level would you prefer for your student teaching placement? School of Education, Health and Human Behavior Student Services Office cannot guarantee you will receive your preference. Middle School endorsement classes must be passed to student teach in a middle school. (Exception: K-12 Art, Music)

10. In which one of the three regions listed below, would you prefer NOT to be placed?
Northern Region Districts Middle Region Districts Southern Region Districts
Alton 11 Central 104 Belle Valley 119
Bethalto 8 Collinsville 10 Belleville 18
Bond 2 East St. Louis 189 Cahokia 187
Bunker Hill 8 Edwardsville 7 Columbia 4
East Alton 13 Granite City 9 Dupo 196
East Alton Wd River 14 Grant 110 Freeburg 70
Gillespie 7 Highland 5 Freeburg 77
Jersey 100 Lebanon 9 Harmony Emge 175
Litchfield 12 Madison 12 High Mount 116
Mount Olive 5 O'Fallon 90 Mascoutah 119
Southwestern 9 O'Fallon 203 Millstadt 160
Staunton 6 Pontiac-Wm Holliday 104 Shiloh 85
Wood River 0 Hartford 15 Roxana 1 Signal Hill 181
  Triad 2 Smithton 130
    Waterloo 5
    Wesclin 3
    Whiteside 115
    Wolf Branch 113

11. Are there any districts in your preferred regions in which you would not want to be placed? You can list up to 5 districts; however, you must include a reason as to why you do not want to be placed in this district.

By submitting this application, I give consent for SIUE to share any educational records, background check information, drug screening information and edTPA information with school partners.

BACKGROUND CHECKS: All students must have a background check clear of all enumerated offenses on file in School of Education, Health and Human Behavior Student Services Office before a placement will be confirmed. Students needing information about the background check should visit

Should the information contained in the background check change, it is their obligation to inform School of Education Student Services Office. Changes in criminal history could impact future placements and/or eventual certification.

DRUG SCREENING/TB TESTS/BACKGROUND CHECKS: Some districts require all candidates to be screened for illegal drugs before being placed in classrooms for observations or student teaching. The drug screening can be obtained in the local area. The drug screening process must be complete prior to placement within classrooms. Students are responsible for the cost of the drug screening. You will be notified if the district in which you are placed requires a drug screening. Some districts also require additional TB tests and/or background checks. You will be notified if the district in which you are placed requires an additional TB test or background check.


The edTPA is an Illinois teaching licensure requirement for all teacher candidates who graduate after September 1, 2015. As part of the edTPA, the teacher candidate must video his/her teaching performance and the impact this instruction has on student learning. Studentsí images and their voices must be recorded and student work samples scanned as evidence that learning occurred. The handling and use of the recordings and the student work samples must be done in such a manner that students and their work remain confidential throughout the process.

Following are your responsibilities in this process:

I will use any student work samples, any audio recordings and/or any video recordings for the sole purpose of the preparation and submission for the edTPA assessment as directed by my instructors at SIUE. I will not use these work samples or recordings for any other purpose.

I will do whatever is reasonable to protect the confidentially of any student work samples, and audio recordings and/or any video recordings of the students that I collect as part of my field experience or student teaching experience. I will only use first names of the students and will avoid using the name of the school and/or district when identifying student work samples or making recordings.

I understand that any scanned student work samples, any audio recordings and any video recordings will ONLY be uploaded to secure servers at SIUE for the purpose of evaluating my teaching knowledge, skills, and dispositions. Also, I will promptly delete any and all of these student work sample images, audio recordings, and/or video recordings from any devices other than the secure servers at SIUE; this deletion will occur absolutely no later than 24 hours after the end of the semester in which the images or recordings were made.

Any questions regarding your placement may be directed to Lindsey Loyd at 650-3940 or e-mail