AY 24-25 Cooperating Teacher Profile

AY 24-25 Cooperating Teacher Profile
Dear Cooperating Teacher:

The Tennessee Department of Teacher Education and Accreditation requires compliance with standards and guidelines regarding well-credentialed K-12 teachers for placement and cooperating of pre-service or student teachers. To assist us with appropriate documentation, please complete this profile. The expertise and service you provide to the LMU Teacher Education Program is greatly appreciated.

Thank you.
Teacher Candidate Name*

First NameLast Name
Program*

ITLU (Undergraduate)MEd ITL (Masters)
The candidate assigned to you will be completing which type of clinical experiences?*

pre-clinical experiences (not student teaching)clinical experiences (student teaching)job embeddedparaprofessional teaching assistant/ GYOClinical permit2 plus 2
Cooperating Teacher/Mentor*

First NameLast Name
License Number*
Cooperating Teacher/Mentor Email*
Cooperating Teacher/Mentor Phone Number

Area CodePhone Number
Cooperating Teacher/Mentor Ethnicity
Optional
University of Cooperating Teacher/Mentor Initial Teacher Licensure*
Certification / Endorsement Area(s)*

BiologyBusiness Education / TechnologyEarly Childhood Education, Grades PreK-3ChemistryMathematicsMiddle Grades Education, Grades 4-8Physical Education K-12Reading Specialist, Grades PreK-3Earth ScienceElementary Education K-6EnglishGeographyGovernmentHealth and Wellness K-12HistoryMusic K-12Special Education K-12Visual Art K-12
Highest Degree of Cooperating Teacher/Mentor*
University of Highest Degree*
Current School's Name*
Current School's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Current Grade Level*

K123456789101112
Current Content Teaching Area*
Years Teaching at Present School*

0-45-1011-1516-2021+
Grade(s) of Previous Teaching Experience*

K123456789101112
Total Years Teaching*

0-45-1011-1516-2021+
Cooperating Teacher Signature:

Clear
Should be Empty: