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Practicum Teacher Request Form
DIRECTIONS: Please complete each section below only if you are interested in being assigned a PRACTICUM STUDENT from the University of Mary for Spring 2013. Upon completion, please "click" the submit button.
Name:
*
Email Address
*
Teaching Grade Level:
*
1
2
3
4
5
6
Type of Classroom:
*
Self-Contained
Departmentalized
School:
*
I will have a student teacher or another practicum student from another university in my classroom this semester.
*
Yes
No
Not Sure, but I will email gsherman@umary.edu if I am assigned another practicum student or student teacher from another university.
For a $50 stipend for each practicum student, I am willing to mentor a practicum student for a full two-week + two day experience in the following block(s).
NOTE
: You may check both, as they are separate weeks; however, it will depend on the number of practicum students enrolled.
*
Block I (Beginning Experience)
Block II (Advanced Experience)
Both Block I and Block II