Clinical Practice Application for Teacher Education

MAT/MAP/PB Candidates:

Must have taken and passed all of the appropriate content test(s) before beginning Clinical Practice. Please request that scores are sent to Muskingum University.
I have taken and passed the appropriate content test(s):

YesNo
Date Taken or Planned:
All Candidates:

Must have a VALID Resident Educator, Professional License, Pre-Service Teacher Permit, Substitute License, and/or Educational Aide permit on file with the university. (send copy to swelch@muskingum.edu)

Additionally, BCI and FBI background checks need to be within one year of beginning clinical practice.

A copy of BCI and FBI background reports must be submitted to Leigh Ann Atkins: Fall Term by May 1st and Spring II Term by December 1st.
Date FBI/BCI Taken or Scheduled:
Date Scheduled:

MonthDayYear
Date
Date Completed:

MonthDayYear
Date
All Candidates Currently Working in a District: Please list current job information.
Current Role:
Current District of Employment:
Current School of Employment:
Principal:
Principal Email:
example@example.com
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone:

Area CodePhone Number
Do you expect to student teach where you are currently employed?

YesNo
If Yes, please provide:
Teachers Name:
Teachers Email:
example@example.com

Your information may be shared with potential placements upon their request.

Candidates Not Currently Working in a District:
Please list below your 1st, 2nd, and 3rd preferences for Clinical Practice. You may NOT request a specific teacher. Although we take all of your choices into consideration, we CANNOT guarantee a placement in any given school.
District (1st Choice):
School:
Principal:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:

Area CodePhone Number
District (2nd Choice):
School:
Principal:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:

Area CodePhone Number
District (3rd Choice):
School:
Principal:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:

Area CodePhone Number

Please briefly outline your career objectives, telling us what you hope to bring to the educational setting:
Please briefly describe your background, including your initial degree(s), hobbies and professional interests:
Type a question
Should be Empty: