JSU Cooperating Teacher Application

Year Long Cooperating Teacher Application

Term you are sponsoring

Additional Term to sponsor

Type of student you are interested in hosting

Requirements for hosting teacher candidates

Practicum Cooperating Teachers must:

have at least 3 or more years of experience in their field
have administrator's approval

Internship Cooperating Teachers must:

be certified in the student's teaching field
have at least 3 or more years of experience in their field
hold a Masters in the student's teaching field OR be Nationally Board Certified (NBCT) *exceptions can apply
have administrator's approval

Personal

First Name

Middle Name

Last Name

Phone Number

Work Phone

Work Email

Spam Field. If you are a human, do not fill in this field.

Birth Date

Social Security Number

Employment

School

Grade Level

Subject Taught

Do you currently teach AAA students this semester?

Yes No

Is your classroom an OSR classroom?

Yes No

Are you employed by additional schools?

Yes No

School 2

School 3

Education

T-Cert Number

Lookup your T-Cert (TCH) Number

Degree

Select the highest degree earned

Degree Area

enter the content area of your degree

Years of Experience

as a certified teacher of record for the current academic year (number only)

Certifications

Please list each area of certification below and mark the highest certification level you have earned in each

Certification Area 1

Certification Level 1

Certification Area 2

Certification Level 2

Certification Area 3

Certification Level 3

Certification Area 4

Certification Level 4