Education Department

Student Teaching Application for the 2012-13 Academic Year

Due: December 16, 2011

Personal Information:

Bucknell ID #:

Last name:

First name:

Middle initial:

Email address:

@bucknell.edu

Campus box number:

Local phone number:

Home address line one:

City:

State:

Zip/Postal code:

Country:

Home phone number:

Transportation
(select 1)

I have no transportation

I will provide my own transportation only

I can take 1 other person in my car

I can take 2 others in my car

I can take 3 others in my car

* Bucknell will reimburse your mileage if you drive one or more student teachers in your personal vehicle.

Do you currently have a:

3.0 or better overall?

Yes

No

If you answered no, please explain your situation:

Preferred Semester:
(not guaranteed):

Fall 2012

Spring 2013

Student Teaching Course:
(select one)

EDUC 349 & 449 Elementary Student Teaching & Seminar

EDUC 359 & 459 Secondary Student Teaching & Seminar

EDUC 649 & 648 Grad-Level Elementary Student Teaching & Seminar

EDUC 659 & 658 Grad-Level Secondary Student Teaching & Seminar

Certification

Primary certification area:

Secondary certification area:
(if seeking dual certification)

Grade Level Preference:

Semester requests, choice of grade level, and teaching content are dependent upon the availability of cooperative teachers and are not guaranteed.

1^st choice:

2^nd choice:

3^rd choice:

Fall 2012 Course Schedule
(Enter elective if not sure)

Dept.	No.	Title	Required?
			Yes    No
			Yes    No
			Yes    No
			Yes    No
			Yes    No

Spring 2013 Course Schedule
(Enter elective if not sure)

Dept.	No.	Title	Required?
			Yes    No
			Yes    No
			Yes    No
			Yes    No
			Yes    No

Additional Information:

Please comment on any aspect of your scheduling that you wish to be taken into consideration when placements are made: