APPLICATION FOR PRECLINICAL PLACEMENT
INSTRUCTIONS and IMPORTANT INFORMATION
PLEASE READ
REQUIREMENTS FOR ENROLLMENT:
-You must have a 2.75 Benedictine University GPA to apply for and enroll in all preclinical experiences.
-Students must register for the preclinical course and the corresponding academic course.
INSTRUCTIONS:
-Applications are available at the School of Education web page at http://www.educationhome/forms/asp.
-Preclinical applications are completed concurrently with course scheduling during academic advising for the upcoming semester.
-A separate application must be submitted for each preclinical experience.
-Applications must be typed.
-Applications must be signed by the student and his/ her Education advisor, then submitted immediately to the Preclinical Specialist, Kindlon 258.
-If you drop or withdraw from a preclinical course, notify the Preclinical Specialist immediately! It is your responsibility and not your advisors to cancel your paperwork for a preclinical placement! The Preclinical Specialist can be reached at (630) 829-6298.
PLACEMENT:
-Without a completed preclinical application, placement(s) will not be processed.
-Placements are made by and MUST be coordinated through the School of Education Office.
-When a placement has been approved, you will be informed by letter during the second week of the corresponding course. You will be requested to contact the appropriate person within one week to arrange a meeting. The purposes of this meeting are to receive final approval (if granted) and to establish your tentative schedule (refer to scheduling, below).
SCHEDULE:
-Preclinical experiences may not begin until the second week of classes and shall be concluded no later than the last day of classes.
-The student’s preclinical schedule (i.e., number of days per week and hours per day) must be approved by the cooperating teacher (in consultation with the University Supervisor).
PLEASE NOTE:
-Applications will not be processed without the advisor's signature.
-It is against school policy for students to be placed in a school they previously attended.
-The School of Education will not switch or replace students once a placement site has been approved by
the school or district. Only extenuating circumstances will be considered.
-Students are required to have a preclinical experience in at least one multi-cultural setting. A multi-cultural setting is defined as a student body consisting of a twenty-percent or more minority population.
Yes, I have read, understand and agree to the above procedures and regulations associated with preclinical placements.
APPLICATION FOR PRECLINICAL PLACEMENT
Last, First / Graduate degree and certification
Student ID#:
REQUESTED SEMESTER OF PRECLINICAL:
PRECLINICAL COURSE REQUESTED:
EDUC 200/400 (initial)
EDUC 316/425 Elem. Math./Teaching Math.
EDUC 321/430 Reading/Assess. & Corr. Read.
EDUC 354/443 Middle School Meth/ Curr & Inst.
EDUC 350/431-436 High School Methods in
EDUC 356/455 Classroom Management
EDUC 358/460 Lrng Beh Methods of ID
EDUC 361 Lrng Beh Methods of LD
EDUC 366 Lrng Beh Methods of ED
EDUC 626 Lrng Beh Methods Childr. w/ LD & ED
Number of clock hours for this experience: # of hours
PERSONAL DATA:
If you live on Campus Campus Address: / Phone: / --Home Address: / Phone: / --
-
City State Zip
Are you a commuter student?
EMPLOYMENT DATA:
Do you work? How many hours per week?
Work Address:-
City State Zip
Major: / Emphasis/Minor/Disciplinary Minor:Cumulative Benedictine University GPA:
If no Benedictine University GPA, indicate GPA for most recent institution:
Institution: / GPA on / point scale, for / sem. hrs.Memberships, recognition and service at University level:
High School:
Name
/City
/State
PRECLINICAL EXPERIENCES COMPLETED (include completed preclinicals and those in progress):
Preclinical Course / School / Town / Subjects / Grade Level(s) / # of Clock Hrs.03540
03540
03540
03540
03540
03540
.
PREFERENCE FOR GRADE LEVEL: Please note that the School of Education makes every effort to place students in a variety of grade levels as determined by their certificate area.
Elementary
/Secondary
/ Special Education/
Primary (K-2)
/ /Middle/Junior High (6-8)
/ /Elementary (K-8)
/Intermediate (3-5)
/ /Senior High School (9-12)
/ /Middle/Junior High (6-8)
/Middle/Junior High (6-8)
/ / / /Senior High (9-12)
General Location Preference (preference not guaranteed):
PREFERENCE FOR TYPE OF INSTITUTION:
Public / Private / Parochial / Alternative SchoolPlease check here if you intend to student teach in a parochial or private school.
SIGNATURES:
The information provided is correct and has been verified by the academic advisor. The Preclinical Specialist must be contacted with any changes to the above prior to the start of the semester.
Applicant:______Date:______
Academic Advisor in Education:______Date:______
Placement Coordinator:______Date:______