Name: Phone: Advisor

Directions: Complete the form by typing into the shaded portions. Save the file, print it, sign where indicated, and meet with your adviser for his/her signature. Add attachments as requested and submit complete application to the Education Department office by the deadline indicated to avoid being charged a late fee of $50.00.

Name: Phone: Advisor:

Address:

Major: Elementary (K-8) Secondary (5-12) Art (K-12)

Music (K-12) Physical Education (K-12)

Endorsement(s)that will be completed by the time of graduation—refer to the on-line GV catalog for number(s) and title(s):

1. I plan to student teach: Fall 2011 Spring 2012

2.I have completed (or will complete PRIOR TO my student teaching semester) all coursework for my major and at least one of my endorsements: Yes No

3. GPA Status:

a. My cumulative GPA is 2.5 or higher. Yes No

b. My GPA is 3.0 or above for all coursework in my major. Yes No

c. My GPA is 3.0 or higher in EACH of my endorsements. Yes No

d. My grades for all major and endorsement courses are C or higher. Yes No

NOTE: If you answered "No" to any question in #3, please provide a typed explanation on an attached 8 ½ x 11 sheet of paper describing how the deficiency(ies) will be resolved PRIOR to student teaching. If the deficiency is not resolved, you will not be eligible to student teach as planned. Sign and date the explanation.

4.The following documents are attached to this application:

a. Documentation of a TB test taken within the last three years Yes No

b. Copy of my Petition for Graduation

(with accompanying program and endorsement evaluations) Yes No

If you have already received a response from the Registrar’s Office regarding the status of your petition— approved or not approved— , also attach a copy of the audit sheet. If you have not yet submitted a Petition for Graduation, download the form from , complete the form, and meet with your adviser prior to submitting it to the Registrar. Attach a copy here.

c. Autobiographical Essay Yes No Summarize how the preparation you have received to date has given you the necessary knowledge, skills, and

dispositions to be a competent student teacher. What has your courses and practica taught you about teaching? What beliefs do you have about teaching? This essay will be shared with your cooperating teachers as a means of introduction. Limit your essay to one typed page,12-point, 1-inch margins. Be sure to spell check your essay and have your adviser proof read your work. The Writing Lab is also a great resource to use prior to submitting your essay to your adviser. You’re selling yourself to a potential employer, so put your best foot forward.

Grand View Student Teaching Application, page 2

5.Assurances:

a. Have you ever been convicted of a felony? Yes No

b. Have ever been convicted of a crime other than parking or speeding

violations (report any OWIs)? Yes No

c. Do you currently have any pending criminal charges against you? Yes No

d. Have you ever had a founded report of child abuse made against you? Yes No

e. Have you ever had an educational license denied, revoked or suspended? Yes No

f. Are you a United States citizen? Yes No

g. Have you ever been charged with a violation of the GV Student

Code of Conduct? Yes No

NOTE: If you answered "Yes" to any question in #5 (other than f.), please provide a typedexplanation on an attached 8 ½ x 11 sheet

of paperexplaining the circumstances in detail, including dates, how resolved, etc. Sign and date the explanation.

6. Certification:

I certify that the information provided on this application is full, true, and correct to the best of my knowledge and that no information required to be given, either expressly or by implication, has been knowingly withheld. I understand that answering questions erroneously or providing false information on this application is grounds for dismissal from the Teacher Education Program at Grand View University and may jeopardize my eligibility for a teaching license in Iowa.

Applicant’s Signature: Date: ______

Advisor’s Signature: Date: ______

7.Factors Affecting Student Teaching Placements:

a.Particular Schools—The Iowa Department of Education recommends that teacher education students have as many different opportunities as possible to observe and interact with students and teachers in a variety of school districts, buildings, and classrooms. They further recommend that student teachers not be placed in schools they attended, where they completed practicum experiences, where their children attend(ed), or where close relatives are employed. Therefore, the following information is needed to make the best student teaching placements for you.

• HS you attended (if located in Iowa):
• MS/JHS you attended (if located in Iowa):
• ES you attended (if located in Iowa):
• School(s) your children attend(ed) (if located in Iowa):
• School(s) where close relatives work (if located in Iowa):

b.Practicum Placements—Please list your practicum placements below.

• First Practicum Experience (District/School/Teacher):
• Second Practicum Experience (District/School/Teacher):
• Additional Practicum(s) required for endorsement(s) [District/School/Teacher]:

c.Specific Endorsement Requirements—Student teacher placements must also satisfy licensure requirements by the Iowa Department of Education and the Board of Educational Examiners as well as Grand View University Teacher Education Program requirements for the specific endorsement(s) being pursued. For example, elementary education majors must student teach at both the primary and the intermediate levels. Students earning a special education endorsement will student teach 8 weeks in a special education classroom and 8 weeks in a regular classroom. Earning the PreK/K endorsement at Grand View requires an additional two weeks of student teaching, for a total of 18 rather than 16 weeks of student teaching. This extra time allows for three placements of six weeks each in a PreK, K, and Intermediate classroom. The additional two weeks can be accommodated within both the Fall and Spring semesters with minor adjustments in the start and ending times for the student teaching experience. Secondary education majors at Grand View are placed eight weeks at the middle school/junior high level and eight weeks at the high school level, unless the endorsement being earned is taught only at the high school level (for example, Biology). During the student teaching semester, students operate according to the schedule of the assigned school and district, rather than according to Grand View’s course schedule. Art, Music, and Physical Education K-12 majors receive both an elementary and a secondary school placement.

Grand View Student Teaching Application, page 3

d. Preference For Student Teaching Placements: Students should not attempt, under any circumstance, to arrange their own student teaching placements. Student teaching assignments are finalized by the Education Department of Grand View University in conjunction with local school district administrators. Each school district has its own procedure for identifying experienced teachers who are qualified to be cooperating teachers, who are recommended by their principals, and who are personally willing to accept a student teacher. Placements are becoming more and more difficult to secure in some districts. Therefore, once placements are made, changes will not occur unless an extenuating circumstance develops and is one that cannot be resolved successfully.

Students may indicate a preference for a particular placement, but placement in a preferred district cannot be guaranteed. Final placement decisions will be made based on prior practicum placements, availability of cooperating teachers in each district, major/endorsement requirements, and other factors as recommended by the Iowa Department of Education, the Board of Educational Examiners, and the Grand View University Education faculty.

Indicate below your 1st, 2nd, and 3rd choice of districts for your student teaching experience, keeping in mind where your practicum placements were located. It is Grand View’s goal to give every Education student field experiences in at least three different districts between practicum and student teaching placements.

Adel-Desoto-Minburn Des Moines Public Schools Norwalk Waukee

Ankeny Grimes Center/Dallas Saydel

Ballard/Huxley Johnston Southeast Polk

Bondurant-Farrar North Polk Urbandale

Private/parochial school No preference West Des Moines

NOTE:Out-of-the-area (greater than 20 minutes) and out-of-state placements are rarely made and only under extenuating circumstances. Such placements are discouraged due to rising gas prices and difficulty in providing adequate weekly supervision. A specific request for such a placement must bemade in the space below and a detailed rationale for the request must be included. Living in area outside of the Des Moines Area is not considered a valid reason for an out-of-area placement unless undue hardship can be documented. Simply making the request does not guarantee approval. A follow-up meeting to discuss your request will be scheduled by Mrs. Brindle. Such a request will only be considered if an extenuating circumstance exists, if an appropriate placement can be found, and if adequate weekly supervision can be arranged.

An additional fee is charged for placements beyond a twenty minute drive of Grand View University ($750) and for

out-of-state placements ($1,500 or more, depending on the cost charged for contracted supervision). This fee is not a part of tuition costs and must be paid by check/money order directly to the Education Department prior to the start of the student teaching experience.

Specific Request & Reason(s) for the request:

Please list below any extenuating circumstances, not otherwise described, that would prohibit you from student teaching in a particular district:

8. For Your Information:

a. Student teaching is considered a full time commitment.

• Additional coursework may not be taken along with student teaching.

• Student teachers follow the same daily schedule as their cooperating teacher and must be available for additional duties as assigned.
• Attendance at after-school, on-campus student teaching seminars on designated dates is mandatory.
• Student athletes should plan their student teaching experience in the off semester of their sport. As a rule, student athletes may not participate in their sport the semester of student teaching.
• Students should also avoid or severely limit their involvement in other extracurricular activities that could potentially interfere with fulfilling student teaching responsibilities.
• Employment during student teaching is strongly discouraged.
• Exceptions to current policy and practice will be considered on a case by case basis. Any extenuating circumstance that conflicts with these guidelines should be explained here:

b. Students may student teach with up to 6 hours of General Education requirements yet to be completed. List any

General Education course work you plan to take AFTER student teaching:

Application for Student Teaching Fall 2011/Spring 2012Updated 10/10