Form: AEOP Student Teaching Application

Owner: Field Experience Administration <fieldservices>
Owner's Email: edu-fieldservices@chaminade.edu
Dataset: ST Application F2010
EDIT: Y, VIEW: N, REQR: N
1
Last Name
EDIT: Y, VIEW: N, REQR: N
2
First Name
EDIT: Y, VIEW: N, REQR: N
3
Middle Name
EDIT: Y, VIEW: N, REQR: N
4
Student ID #
EDIT: Y, VIEW: N, REQR: N
5
Program/Placement
EDIT: Y, VIEW: N, REQR: N
6
Program Level
Undergraduate
Graduate
EDIT: Y, VIEW: N, REQR: N
7
Email address- personal
Please note that all correspondence will be done via official CUH student email account.
EDIT: Y, VIEW: N, REQR: N
8
Phone number
EDIT: Y, VIEW: N, REQR: N
9
Home Address STREET, CITY, STATE, ZIP CODE
EDIT: Y, VIEW: N, REQR: N
10
Current GPA
EDIT: Y, VIEW: N, REQR: N
11
Are you already a contracted full time teacher?
Yes
No
EDIT: Y, VIEW: N, REQR: N
12
If answer to #12 is yes, please list the location of your employment.
A supportive letter from your principal and a copy of your teaching contract is required for you to do student teaching in your own classroom setting. Please see Field Services website for more details at www.chaminade.edu/education under Licensing Programs and Field Services to see details about In Service/Validation Student Teaching.
EDIT: Y, VIEW: N, REQR: N
13
If you are not already a contracted full time teacher, please list up to three district preferences.
EX: Leeward, Central, Windward
Although you can list your district preference it WILL NOT guarantee that you will be placed in this district.
EDIT: Y, VIEW: N, REQR: N
14
Please list your previous/current OP sites.
EDIT: Y, VIEW: N, REQR: N
15
If you have courses still in progress, please list:
EDIT: Y, VIEW: N, REQR: N
16
If you have Praxis scores pending, please list test number(s) here:
**Failure to submit passing PRAXIS scores before the deadline date will deny your placement for the term you are applying to.
EDIT: Y, VIEW: N, REQR: N
17
Please list your Praxis tests and scores here.
EDIT: Y, VIEW: N, REQR: N
18
Please list the names of the Education Faculty members from which you've requested a recommendation.
You will need 3 positive recommendations in order to student teach.
Faculty can access the form by going to their LiveText account and searching for the Faculty Recommendation Form.
EDIT: Y, VIEW: N, REQR: N
19
Have you ever been brought up on Disposition Issues? If so, please explain.
EDIT: Y, VIEW: N, REQR: N
20
Please list your student NEA ID number and the expiration date here.
The student NEA membership must be renewed each academic year.
EDIT: Y, VIEW: N, REQR: N
21
Have you been fingerprinted by the Hawaii DOE within the last year?
Yes
No
EDIT: Y, VIEW: N, REQR: N
22
What is the date on your most current TB clearance card?
If Field Services does not have this on file for you, you must submit a copy. TB clearances expire every 2 years.
 (MM/DD/YYYY)
EDIT: Y, VIEW: N, REQR: N
23
Graduation clearance was filed with academic advisor on:
EDIT: Y, VIEW: N, REQR: N
24
Please list any special notes here.
You will be contacted via CUH student email regarding placement and orientation meeting information. Please do not contact the Education Division to check on your placement status.