Application for Student Teaching

Personal Information
Last Name *
First Name *
M.I. *
Maiden/former name(s)
Address *
City *
State *
Zip Code *
Home Phone *
Cell Phone *
Work Phone (Optional)
Drury e-mail address *
Drury ID
Date of Birth (mm/dd/yyy)
Additional Information
Choose your enrollment status:
Choose the semester you plan to student teach:
Area of Certification Desired:
Elementary Education (grades 1-6)
Middle School (grades 5-9)
Troops to Teachers (grades 5-9)
Secondary (grades 9-12 or K-12)
Special Education - DATSE students only (grades K-12)
What grade level placement do you request?
Where have you completed your field experiences prior to student teaching?
Provide two placement requests indicating the school district and school building.
Attach your autobiography in .PDF format. (Please keep file size under 2 Mb)
Attach a professional-looking photo, which will be provided to your cooperating teacher and other district personnel. (Please keep file size under 6 Mb)

Transcript and Data Release

I authorize the Drury University Registrar to prepare copies of my undergraduate and graduate transcripts to be included in my School of Education and Child Development file. These transcripts will be used in determining my eligibility for student teaching and academic information may be shared with school district personnel, including my cooperating teacher and university supervisor. I also understand that the School of Education and Child Development is required to report annual data to the U.S. Department of Education and Missouri Department of Elementary and Secondary Education in accordance with Title II regulations. Information reported may include, and not be limited to, academic and demographic information (i.e. Social Security Number, standardized test results, gender and ethnicity).

I agree to the transcript and data release

I understand that the School of Education and Child Development is required to report academic and demographic data

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