|School of Education, Health and Human Behavior
CI 315A - PRE
FIELD EXPERIENCES APPLICATION
Applications are due in School of Education, Health and Human Behavior Student Services Office (1st floor, Founders Hall, Room 1110) by
Friday, September 5th, 2014
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
Enter the information
on the screen and submit.
Print off the
Authorization of Eligibility form that will appear once you hit submit.
Bring this form to your major advisor for signature.
Print off the
Student Profile Sheet
instructions and prepare your student profile.
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
field experience requirements and complete as required.
select your program of study below:
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?
Students are not allowed to proceed in CI 315A if they
have not passed the TAP Test.
If not, please list date you are registered to take the test
6. Will you have the middle school endorsement courses completed by the end of your student teaching semester?
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?
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
Any questions regarding your placement
may be directed to Lindsey Loyd at 650-3940 or e-mail