Student Teaching Application - Hannibal-LaGrange University

I understand that I will have to complete student teaching in a different school district if I have completed all of my field experience hours in the same school district.*

Yes

I have created a DESE profile.*

Yes

I have a background check on file in the HLGU Education Division which will be valid through my entire student teaching semester. IF not, I understand I must complete a new background check.*

Yes

I understand that I must have current Professional Education Liability Insurance during the student teaching semester. S-MSTA membership provides this liability insurance to you for free as long as you are student teaching in Missouri. Complete S-MSTA membership at https://members.msta.org. If you are a “Teacher of Record,” or if you are completing your student teaching in another state, S-MSTA membership is not available to you and therefore different proof of Professional Education Liability Insurance is required. Send proof of insurance to education@hlg.edu.*

https://members.msta.org

Yes

I have paid local S-MSTA dues of $5.00.*

(Hannibal main campus students pay the education department office manager, TRC campus students pay the TRC Site Coordinator. Online students are exempt.)

Yes

I understand a Missouri Content Assessment score must be on file in the Education Division office in order to graduate.*

Yes

Upload the "Statement of Graduation Requirements" sent to you via email from the Registrar's Office.*

Upload your professional résumé. You can view a résumé template at the link below.*

Resume Template

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Campus*

Campus Box Number

Cell Phone*

HLGU Email*

Degree*

Major Certification Area*

Have you been employed in a public school for at least two years as a teaching assistant?*

Yes
No

If yes, please upload your verification form.

Are you currently employed in a public school as the teacher of record?*

Yes
No

Current Grade Point Averages

The Department of Elementary and Secondary Education has established minimum GPA requirements as listed below. If you need help calculating each GPA, feel free to use this online GPA calculator.

Cumulative GPA (min. of 2.75) This GPA is automatically calculated for you on your unofficial student transcript.*

Professional GPA (min. of 3.0) Calculate this GPA using all classes with EDU, ECE, EED, or SED course numbers.*

Content GPA for K-12 and SED only (min. of 3.0) Calculate this GPA using classes under the content area heading on your Graduation Checklist

Expected Date of Graduation*

Semester Planning to Student Teach*

Advisor*

I plan to participate in an HLGU sport during student teaching.*

Yes
No

If yes, list the sport and coach's name.

List coursework in which you are currently enrolled.

School District Preference

The district you request must be within a 50-mile radius of HLGU or extension site (undergraduate students only). If you are an undergraduate student who would like to student teach beyond this boundary, you must write a letter to the Teacher Education Committee explaining your extenuating circumstances and requesting permission to teach beyond HLGU’s boundary. Submit this letter via email to education@hlg.edu.

Graduate students must also complete this school district preference section.

Candidates will not be approved to complete all HLGU field experience placements (including student teaching) in the same district/school.

Candidates may request a placement in the school in which they attended as a student, but this request will not be approved unless the candidate has been gone from that school for at least ten years.

School preference not guaranteed.

*

I understand the policies written above.

First Choice District

District Name*

School Preference*

School Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

School Phone*

Principal's Name*

First Last

Principal's Email*

Second Choice District

District Name*

School Preference*

School Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

School Phone*

Principal's Name*

First Last

Principal's Email*

Grade Level Requests

Please select your first, second, and third choice. Selected requests are not guaranteed.

Select One*

ECE First Choice

ECE Second Choice

ECE Third Choice

EED First Choice

EED Second Choice

EED Third Choice

SED First Choice

SED Second Choice

SED Third Choice

K-12 First Choice

K-12 Second Choice

K-12 Third Choice

SED and K-12 Subject Area

What schools did you attend as a student?*

In what schools are your children or siblings enrolled?*

Do you have relatives who are administrators, faculty, or staff at a school? If so, what school(s)?*

In what schools have you been placed for field experiences or practica?*

Will you live on campus while student teaching?*

Yes
No

Additional comments regarding your student teaching placement

By submitting this form, you agree to the following:

I understand that in order to enter, remain in, and exit from the HLGU Teacher Education Program, I must comply with all institutional and state requirements. My failure to comply with any institutional requirement (including HLGU student conduct regulations) or state requirement could result in my being dismissed from the program, making me ineligible to be recommended for certification. I understand that by virtue of my enrollment in teacher education courses at Hannibal-LaGrange University and by participation in various classroom activities (i.e., educational field experiences and student teaching), I may have access to records which contain individually identifiable information. The disclosure of this information is prohibited by the Family Education Rights and Privacy Act of 1974 (Buckley Amendment). I acknowledge that I fully understand that the intentional disclosure by me of this information to any unauthorized person (i.e. talking about a particular student or teacher to a friend) could subject me to criminal and civil penalties imposed by law. I further acknowledge that such willful or unauthorized disclosure could constitute just cause for disciplinary action and/or removal from the teacher education program by Hannibal-LaGrange University's Teacher Education Division regardless of whether criminal or civil penalties are imposed.

*

I agree to the above confidentiality statement.