Submit by February 1st for Fall Placement
Submit by October 1st for Spring Placement
 
First Name Middle Name Last Name
   
Email Address Phone Number
 
Local Address
Street
City State Zip Code
 
     
Permanent Address
Street
City State Zip Code

Schools Attended
  Name Location Dates

Elementary:

Middle School:

High School:

Other Colleges:

Semester that you plan to teach

Expected Graduation or Completion(FTTT) Date

Factors that influenced you in your decision to be a teacher

 
Experience Working With Children/Adolescents

Practica
Type of placement Location Age/Grade Level Length of Time
Other experience (nanny, tutor, coach, etc.) Please include location, age level and length of time.
College Activities/Organizations
Honors/Scholarships (begin with most recent)
Activities (clubs, drama, music, athletics, organizations)
Interests, hobbies, areas of expertise

Overall GPA:

Date PPST Passed:
I have not yet taken the PPST

Endorsement(s)
Check all that apply
Early Childhood Education B-3    
Early Childhood Unified B-3    
Elementary Education K-6    
Special Education Mild/Moderate K-9    
       
Secondary Grades 7 - 12
Basic Business Language Arts Religion
Biology Mathematics Spanish
Chemistry Natural Science Social Science
English Reading    
           
Middle Grades 4-9
Art Natural Science
Basic Business Social Science
Language Arts Special Education
Mathematics World Language
       
K-12 Endorsements Supplementary Endorsements
Art K-12 English as a Second Language
Health & Physical Education 7-12 Information Technology
Religious Education Coaching
       
Other
 
   

Grade Levels Preferred

(ECE MAJORS SEEKING ECE ENDORSEMENT in Iowa must have one placement in pre-kindergarten)
PK KDG 1-3 4-6 7-9 9-12
Preferred academic level of students in student teaching placement:
Below Average Gifted
Average No Preference
Above Average    
Please specify if you would like to be assigned to a particular teacher/s and/or school for your student teaching experience:

Teacher

Grade/Subject

School
     
 
Please indicate reason(s) why you feel you should have your student teaching assignment in a particular area of the city or in a particular school district.

Write a brief autobiography (maximum 200 words).

(You may paste into this box from other programs)

I understand that I may be placed in placements other than those indicated above, and I accept such assignments.