Student Teacher Placement Application – Strands 2 and 3
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. This application will be shared with MAT faculty and school personnel.

Name:
Undergraduate Major:
Degree(s) (BA, BS, MS, etc.) and Institutions:
Current Address:
Current Phone:
Summer Address (if different):
Summer Phone:
Email:
Strand:
1. Please indicate where you will be living while attending Willamette:
  Salem
Portland
Corvallis
Other:
Don't Know
2. Will you have a car?
  Yes
No
3. We make placements in three districts. Please select your choices or check "doesn't matter":
First choice:
Second choice:
Third choice:
Doesn't matter
If any of your choices are "other", list your desired placement district(s):
4. Have you had any experience with a school(s) in one of the districts in which we work? If so, which ones:
5. Indicate at what level you would like to do your student teaching:
  Early Childhood
Elementary
Middle School
High School
6. Indicate at what level you would like to do an additional practicum experience for a second level of authorization:
  Early Childhood
Elementary
Middle School
High School
7. If you chose Middle School or High School, what subject(s) do you intend to teach?
Background:
1. Assess your experience with the following:
Classroom management
Assessment
Planning
Instruction
2. Briefly describe your relevant work/volunteer experience with children.
3. Briefly describe areas of special interest and expertise in your teaching field(s).
Student Teaching:
4. What are your expectations of student teaching?
5. Describe the type of classroom setting where you feel you will be the most successful as a student teacher.
6. What do you expect from your supervising teacher?
Personal Interests:
7. 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 and your criminal background statement to:

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

Thank You!