STAGE Overseas Student Teaching Application - Part 1
Semester to student teach (e.g. Fall 2024)
Section 1: Personal Information
Name
First Name
Last Name
Student's College/University Address
Street Address
Street Adress Line 2
City
State / Province
Postal / Zip Code
Student's Phone Number
Please enter a valid phone number.
Student's Email
example@example.com
Student's Permanent Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student's Passport Country/Countries
Section 2: Vaccination Policy
The COVID vaccination requirements continue to change around the world. With proof of a COVID vaccine, most countries are open for travel, and many are open without it. Due to the frequent changes in requirements, it is helpful for us to know this information about you.
Please check all that apply
I understand that I may be required to submit proof of vaccinations to either STAGE or an international school.
I understand that there are countries that will be unavailable to me without a COVID vaccine.
I understand that if I have been placed, and the vaccination requirements change, I will not receive another placement.
I have had a COVID vaccination
Please Select
I am fully vaccinated
I am partially vaccinated
No
Other
If other, please explain:
Section 3: Emergency Contact Information
Family/Personal Contact Person
Full Name
Relationship
Family/Personal Contact Person - Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
STAGE Campus Coordinator
Name
Department
Phone Number
Please enter a valid phone number.
Email
example@example.com
Section 4: Education
College or University
Anticipated Date of Graduation
College Major(s)
College Minor(s)
Certification Sought
Content Areas
Grade Levels
Additional training/certification already achieved (e.g. TESOL, First Aid, Water Safety Instructor)
List the field experience and/or student teaching/clinical experiences completed (or to be completed) prior to departure
Section 5: Placement Requested
Please read and check the following statements to agree
I understand that meeting the requirements of my program takes precedence over a desired location or grade level. I understand that STAGE will genuinely try to honor my priorities and preferences.
I understand that placements are subject to the availability of the site requested.
Grade Level range required for licensure
Grade level preferred for placement
Content area(s) required for licensure (if applicable)
Content area(s) preferred for placement
Classroom criteria required for licensure (e.g. special education, TESOL, etc.)
Additional Classroom criteria preferred
If you know, what are the dates for your student teaching overseas?
If there are specific date/time limitations to your international student teaching experience, please inform us now.
Why do you want to do your student teaching internationally?
Section 6: Educational Perspective
Please write a summary of your educational perspective. Include information about why you intend to teach, what formative experiences have led you to this, and what personal strengths, skills and interests will enhance your performance in the classroom.
Section 7: Interests and Experiences
List your hobbies and interests, including sports, clubs, organizations and other skills and abilities you have.
Describe previous cross-cultural experiences and/or international travel. Please list the languages (besides English) that you have studied, and describe your level of proficiency.
Section 8: Health Information
International schools carry a level of responsibility for you during your student teaching. The following information is to help them determine if you can be successful in your student teaching in their context.
Do you have any physical impairments or disabilities that might restrict your mobility or require special facilities or assistance while you are student teaching overseas? Please be as specific as possible.
Do you currently receive academic accommodations at your university that you would expect to have at your international placement? Please be as specific as possible in your description of the accommodations.
Do you have any significant chronic medical conditions requiring ongoing medical supervision or treatment, or have you had in the past any significant condition that is currently in remission? If so, please describe.
Do you have any emotional, physical, or medical conditions, past or current, that would cause discomfort or problems during travel, change of climate, change of diet, or strenuous activity? If so, please explain.
Are you currently receiving, or have you received in the last two years, treatment for any emotional problem, eating disorder, drug addiction, alcoholism or psychiatric condition? Please specify.
Do you have allergic reactions to any of the following?
Aspirin
Bee Stings
Peanuts
Penicillin
Sulfa Drugs
Codeine
Other (please specify below)
If other, please specify here
If you said yes to any of the above, please comment on how you would deal with an allergic reaction
Please list any special dietary needs you may have
Please tell us anything else you would like us to know about yourself
Section 9: Additional Information (Optional)
Please tell us anything else you would like us and your placement school to know about you
Section 10: Christian Background
Please write a summary of your Christian testimony. Include information about how you came to know Jesus Christ as your personal Savior, your growth as a Christian, and your current walk with Christ.
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