CI 315A - PRE
FIELD EXPERIENCES APPLICATION
Applications are due in School of Education Student Services Office (1st floor, Founders Hall, Room 1110) by
Friday, September 13th, 2013
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 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 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 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 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, PE)
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 and drug screening
information with school partners.