FIELD EXPERIENCES APPLICATION
Applications are due in School of Education Student Services
Office (1st floor, Founders Hall, Room 1110) by
Friday, September 13, 2013
A. Please select your program of study below:
List major area
1. General Information
2. Will you be living on campus?
3. If yes, list campus address if different from above address:
4. School attended (include city and state).
Do not list previous placements, but the school you attended.
5. Secondary Education students - 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.
7. 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.
Verification of Eligibility
||I believe that my advisor can verify my eligibility.
||I understand that I cannot student teach at a school from which I have graduated or one in which a relative is currently employed or attending. It is my responsibility to let
School of Education Student Services Office know if a placement is made in which this would occur.
||I understand that I must have completed all general education, major and minor requirements prior to student teaching or have the approval of my
School of Education Student Services Office advisor.
||I understand that if for any reason I withdraw from the program, a new student teaching application must be submitted and an updated signature from my advisor must be provided to
School of Education Student Services Office by the posted deadline for any future semester.
||Submission of the application packet by the posted deadline and passing scores on the appropriate content area test are required before a student is registered for student teaching. Passing scores on the APT is required for certification (required for graduation for Special Education majors)
||I understand that I will be withdrawn if, for any reason my overall GPA is below the required 2.5/4.0 or I receive lower than a C in my professional education courses.
||I understand that I must apply for graduation in the Admissions and Records office, after earning 90 semester hours, by the posted deadline (if receiving a degree). It is my responsibility to verify that my General Education requirements have been met.
||I understand that I must notify both
School of Education Student Services Office and the Service Center of any name, address, or telephone changes.
||I understand that I am required by state law to have a negative mantoux
TB test not more than 90 days prior to the first day of student teaching
(After October 16th, 2013). If I am an early childhood major, I must take the two step TB test. Failure to fulfill this requirement will result in the cancellation of my student teaching placement.
||I understand that I need a minimum of 100 documented clock hours of clinical experience in classrooms All final observation sheets must be turned in to
School of Education Student Services Office by the start of the student teaching semester,
with the exception of secondary education, which has the first 4 weeks
of student teaching to acquire the 100 clock hours.
By submitting this application, I give consent for SIUE to
share any educational records, background check information and drug screening
information with school partners.
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.
regarding your placement may be directed to Nancy Waltz at 650-2469 or