Student Teacher Placement Application – Strand 1
2008 – 2009 School Year

This information will be used to make the best possible match between you, your school and your school supervisor. We welcome your candor for there are no right or wrong answers. Please attach a one paragraph note in your own handwriting telling your supervisor what you hope to achieve during student teaching.

Name:
Address in July:
MAT Address:
Phone number in July:
MAT phone number:
Email:
Languages Spoken Frequently:
Type of school preferred (for example: small, rural, large, bilingual):
Elementary school you/your children/your siblings attended (if in local area):
I have read the accompanying information and understand that I may select both a first and second level of authorization.
I would like my first level of authorization to be: Early Childhood (K-3)
Elementary (grades 4-8)
My preferred grade level is:
I would like my second level of authorization to be: Early Childhood (K-3)
Elementary (grades 4-8)
My preferred grade level is:
Signature: ___________________________________________ Date: ____________
Background:
1. Describe your educational background and work experience.
2. How could your experiences be integrated in the classroom?
3. Assess your experience with the following:
Classroom management
Assessment
Planning
Instruction
Experiences with K-5 Students
Teaching and Learning:
4. How do you think children learn best?
5. How do YOU learn best?
6. What is the difference between a good teacher and a great teacher?
Student Teaching:
7. What are your expectations and your commitment to student teaching?
8. Describe the type of classroom setting where you feel you will be the most successful. Explain.
9. What do you expect from your supervising teachers?
Personal Interests:
10. What hobbies, interests, free-time activities do you enjoy?
This information will be shared with school districts for placement purposes.
Check box if you agree to have the information shared with area school districts.
If you have any questions, please contact the School of Education Admissions Director, Debbie Harvey: dharvey@willamette.edu or 503-375-5453.
After you click 'Create Form for Printing' below, you will see a completed document suitable for printing. Please print this document and mail it along with your one-page resume, your one paragraph handwritten note, and your criminal background statement to:

Debbie Harvey
School of Education
Willamette University
900 State Street
Salem, Oregon
97301

Thank You!