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DATSE Student Teaching Application
Drury University
>
School of Education & Child Development
>
DATSE Student Teaching Application
Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Middle Initial
*
Maiden/former name(s)
Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Cell Phone Number
*
Home/Work/Other Phone Number
Drury Email Address
*
Drury ID Number
*
Date of Birth
*
Choose the semester you plan to student teach
*
Fall
Spring
Area of Certification Desired
*
K-12 Mild/Moderate Cross Categorical Special Education
Placement
*
I am already working in a school as a paraprofessional
I am already working in a school on a provisional teaching certificate
I need to be placed in a special education classroom to student teach
Current Placement School
Name of school
Name of school district
City
If already placed in a school, what is the name of your Cooperating Teacher/Mentor? (This is the school based person, assigned to you by your administrator, who will observe and evaluate you.)
I will be enrolling in EDUC 699 for
*
Three hours (employed and teaching on a provisional certificate)
Six hours (employed as a paraprofessional, or completing traditional student teaching)
Upload your autobiography
*
Upload a recent professional looking photograph of yourself
*
If you are teaching on a provisional certificate, upload a copy of your Missouri Provisional Teaching Certificate, or if you are a paraprofessional, upload a copy of your Missouri Content Substitute Certificate.
*
Upload a copy of your most recent certification exam results, or a copy of your registration that shows your name and the date you plan to take the exam.
*
Upload a copy of your current NEA or MSTA member card (for professional liability purposes)
*
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 data release
*
Yes
No
I understand that the School of Education and Child Development is required to report academic and demographic data
*
Yes
No
Submit