Placement Requests_ITLU and MEdITL 2025.2026

Placement Requests_ITLU and MEdITL
Candidate Name*

First NameLast Name
Candidate Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Candidate Phone

Area CodePhone Number
Candidate LMU Email Address*
Candidate Personal Email Address*
Program*
Certification Area*

Elementary (K-5)Secondary Biology (6-12)Secondary Business (6-12)Secondary Chemistry (6-12)Secondary English (6-12)Secondary History (6-12)Secondary Physics (6-12)Secondary Math (6-12)Art (K-12)Physical Education (K-12)Special Education (K-12 Comprehensive)Special Education (K-8 Interventionist)Special Education (6-12 Interventionist)Elemenatary and ELLElementary and SPED (dual)
Status of Clinical Experiences*

Pre-Clinical (before student teaching)Clinical (student teaching)
Semester in Which I Plan to Teach/Observe*

Fall 2023Spring 2024Fall 2024Spring 2025Fall 2025Spring 2026Fall 2026Spring 2027Fall 2027Spring 2028
Have you taken and passed ALL PRAXIS exams?*

YesNo
If you have NOT passed all PRAXIS exams, which do you lack and when do you take?*
Name of District Requested for First Placement*
Name of District Requested for Second Placement for student teaching*
Below, list any specific physical condition, family obligations, or other situation that wil affect your placement for student teaching. This INCLUDES schools where you may have children, other family members, or close friends as placements there will not be permitted. This DOES NOT INCLUDE arrangements for other child care or drop-off / pick-up responsibilities for other children.
Conditions that Affect Placement
Should be Empty: