Student Teaching/Student Observation Request

Student Teaching/Student Observation Request
A letter from your university, college or alternative certification program must accompany this form. Please attach it at the end.
Reason for Request?*
CONTACT INFORMATION:
Name*
Address*
City*
State*
Zip*
Phone Number*
E-mail Address*
example@example.com
Student Teacher Certification Area*
Student Teacher Certification Grade Level*
Assignment Dates*
NAME OF PROGRAM:
University, College, or Alt Cert Program Name:*
Reason for Observation Hours (ex. course requirement, certification requirement, alt cert. program)*
Number of Hours needed*
University/ACP Supervisor*
Specific University/ACP Requirements*
Kennedale ISD Requirments:
1) Student Teaching Placement Request Form

2) Background Check through on-line Raptor system

3) Letter from college, university or Alternative Certification Program stating the number of hours needed.
University or ACP Coordinator Contact Information:
Name*
Title*
Phone*
E-Mail Address*
example@example.com
Applicant Signature*

Clear
Date*

MonthDayYear
Date
Letter from College, University, or Alt Cert Program stating the number of hours needed:*

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Photo of Front of Driver's License *

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Should be Empty: