Applications are due in School of Education Student Services Office (1st floor, Founders Hall, Room 1110) by
Friday, January 31st, 2014

A. Please select from one of the options below

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)


5. 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. 


6. 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.   


BACKGROUND CHECKS: All students must have a background check clear of all enumerated offenses on file in School of Education Student Services Office before a placement will be confirmed. Students needing information about the background check should visit http://www.siue.edu/education/advisement/backgroundcheckinfo.shtml.

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.

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

SPE 418 ONLY  –

Please type the answers to the following questions on a separate document and bring to School of Education Student Services Office (Founders Hall 1110) by the application deadline.  This page will be sent to school districts so proofread your responses as carefully you would your resume.

Your Full Name should be on the top of the document, along with the course number (SPED 418).
List the Special Education courses that you have completed or are currently enrolled in, including the course title, semester and grade.
List any experiences working with children and youth with disabilities.
List any major interests outside of school.
Write a brief autobiography highlighting any experiences with special education.