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Practicum Placement Request (P1 form) W&L

Questions? Contact Rebecca Perini at rperini@wlu.edu.

* Name:

* Home Institution:

* Current University email:

* Anticipated Term of Graduation:

* Declared or Proposed Major:

Declared or Proposed Minor:

* Teaching Endorsement Area: (e.g., Elementary, Music, Secondary Biology, English, etc.)

* I am taking this practicum for:

* Reason for practicum placement:

Teacher Licensure

Education Minor

Education Policy Minor

Other

NOTE: RTEC aims to provide diversity of field experiences by placing you in a different school, division, and grade level each term, across the four practicum terms that are required for teacher licensure. Practicum placements also vary due to availability and scheduling of cooperating teachers.

* Do you have transportation (yes/no):

Indicate ALL possible days/times you are available to complete your practicum hours, including time you need to leave and return to campus.

* Monday

* Tuesday

* Wednesday

* Thursday

* Friday

Please list PREVIOUS practicum placements, service or other work with children:

1. Date: School: Teacher: Grade level:

2. Date: School: Teacher: Grade level:

3. Date: School: Teacher: Grade level:

Additional notes:

* Student Signature:

* Date:

This form will be submitted to the RTEC Director and you will receive a copy. Once your practicum placement has been made, you and the cooperating teacher will be notified and can then determine specific, mutually agreeable times for you to be in the classroom, within the window of times you've indicated above and within the window of times provided to us by the cooperating teacher.

RTEC Form P1