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 TemplateName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Campus*HLGU's Hannibal main campusHLGU's Three Rivers College campusHLGU's Online ProgramCampus Box NumberCell Phone*HLGU Email* Degree*Bachelor'sMaster'sMajor Certification Area*Early Childhood (Birth – 3rd Grade)Elementary (1st – 6th Grade)Elementary with Early Childhood Add-On (Birth – 6th Grade)Art (K-12th Grade)Music Vocal Concentration (K-12th Grade)Music Instrumental Concentration (K-12th Grade)Physical Education (K-12th Grade)Middle School English (5th -9th Grade)Middle School Math (5th -9th Grade)Middle School Science (5th -9th Grade)Biology (9th – 12th Grade)Business (9th – 12th Grade)English (9th – 12th Grade)Mathematics (9th – 12th Grade)Social Studies (9th – 12th Grade)Speech & Theatre (9th – 12th Grade)Unified Science with Biology Concentration (9th – 12th Grade)Have you been employed in a public school for at least two years as a teaching assistant?*YesNoIf yes, please upload your verification form.Are you currently employed in a public school as the teacher of record?*YesNoCurrent Grade Point AveragesThe 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 ChecklistExpected Date of Graduation*Semester Planning to Student Teach*Advisor*I plan to participate in an HLGU sport during student teaching.*YesNoIf yes, list the sport and coach's name.List coursework in which you are currently enrolled.School District PreferenceThe 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 DistrictDistrict Name*School Preference*School Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country School Phone*Principal's Name* First Last Principal's Email* Second Choice DistrictDistrict Name*School Preference*School Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country School Phone*Principal's Name* First Last Principal's Email* Grade Level RequestsPlease select your first, second, and third choice. Selected requests are not guaranteed.Select One*Early Childhood EducationElementary EducationSecondary EducationK-12ECE First ChoiceK123ECE Second ChoiceK123ECE Third ChoiceK123EED First Choice123456EED Second Choice123456EED Third Choice123456SED First Choice9101112SED Second Choice9101112SED Third Choice9101112K-12 First ChoiceK-56-89-12K-12 Second ChoiceK-56-89-12K-12 Third ChoiceK-56-89-12SED and K-12 Subject AreaArtBiologyBusinessEnglishMathMusic (Instrumental)Music (Vocal)Physical EducationSocial StudiesSpeech & TheatreUnified ScienceWhat 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?*YesNoAdditional comments regarding your student teaching placementBy 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.