COVER SHEET
INTERNATIONAL STUDENT TEACHING
Please
complete this cover sheet when you take the application form and return
it to Dr. Keith Dils, 104
Date _______________________
Name _______________________________ Banner ID___________________
Campus Address ______________________ Phone ______________________
_____________________________________
Home Address ________________________ Phone ______________________
_____________________________________
E-mail Address ________________________
______________________________________
Certification Area_____________________________________________________________
Semester that you plan to Student Teach ____________________ Year ________________
COUNTRY:
THE
INTERNATIONAL STUDENT TEACHING
APPLICATION FORM
DATE:
Semester you plan to student teach: ______________ YEAR: ________________
COUNTRY OF INTEREST:
______
NAME: ______________________________ Banner ID: ________________________________
HOME ADDRESS: ________________________ CAMPUS ADDRESS:________________________
________________________ _________________________
PHONE: (____)_________________________ PHONE:(____)______________________
E-mail Address:_________________________
AREA OF CERTIFICATION: GPA:
Early Childhood Overall
Elementary Education Prof. Courses
Secondary Education Major
(Specialty Certification)___________________
Special Education (Please Specify)
Life Skills OR Learning Support
HOBBIES:
AREAS of EXPERTISE: (art, photography, etc.)
EXPERIENCE with CHILDREN:
You will also need to submit the following:
1) Personal Resume - This should include information on past experiences with children, activities, and extra-curricular interests.
2) One Page Summary - Should discuss why you feel teaching in a foreign country would benefit you and the students you will teach.
Signatures of the following must be obtained BEFORE the application is
submitted to Dr. Keith Dils, 104
Advisor
___________________________________________________________ Phone# __________________________
Dept. Student Teaching
Coordinator_____________________________________ Phone# __________________________
Associate Dean of Education ___________________________________________ Phone# __________________________
RECOMMENDATIONS
I feel that _______________________________ will be able to perform effectively in an International (NAME)
Student Teaching Assignment.
ADVISOR: _______________________________ DATE: _________________________________
PLEASE OBTAIN
THREE ADDITIONAL RECOMMENDATIONS FROM DEPARTMENTAL FACULTY.
1) STATEMENT:
Professor's
Signature:
Date:
Department
2) STATEMENT:
Professor's
Signature: Date:
Department
3) STATEMENT:
Professor's
Signature: Date:
Department
INTERNATIONAL STUDENT TEACHING
CHECKLIST
SUBMIT
YELLOW COVER SHEET to 104
*
Slide the sheet underneath the door if no one is in the office.
Signature
From Advisor
Signature
From Student Teaching Coordinator
Signature
From Associate Dean of Education
Personal
Application Information Completed
Advisor's
Recommendation
Three Signed Recommendation (One from Major)
One
Page Summary Attached
Personal
Resume Attached
Responsibilities
Agreement- Signature
This checklist is designed to help you complete the application
correctly. We look forward to receiving
your information. Once the CHECKLIST is
complete, you may return the completed application to 104 Stouffer
TOUCH THE
LIVES
OF CHILDREN
ALL
AROUND THE WORLD.
STUDENT TEACH ABROAD!!
International Student Teaching Understandings and
Responsibilities Agreement
1. Pay the study abroad fee as determined
by the university.
2. Make
arrangements and pay for air fare and transportation costs to and from the
student teaching site.
3. Pay for transportation while at the
student teaching site.
4. Be responsible for all personal
expenses.
5. Continue
to maintain high quality academic performance throughout the duration of the
experience.
6. Understand that the site coordinator is
the first line of communication in all matters.
7. Upon
arrival, a payment plan for all room and board will be determined in
conjunction with the site coordinator and the host family with an agreed upon
schedule of payment. Arrangements for
making phone calls will be established with the host family and respected.
8.
Students will
have appropriate medical coverage, including health insurance and life
insurance. Proof of insurance will be
required of each student before departure from the
9. All
expenses owed for room and board, telephone and other debts incurred must be
paid prior to leaving the country.
Failure to settle all accounts will result in “holds” being placed on
diplomas and transcripts from IUP.
I,______________________________ accept the conditions of the IUP
International Student Teaching Partnership Agreement for the academic semester
______________________, as well as the financial responsibilities outlined in
the partnership agreement. I understand
that, while every precaution will be taken by IUP and the International Student
Teaching Partner Institution, neither institution (nor agents thereof) can be
held legally liable for any mishaps which may occur. In particular, I recognize
the risks associated with air, rail, and automobile travel (whether public or
private). I understand that I must have
appropriate health, life and property insurance, and if such insurance policies
lapse, I recognize that no liability rests with either institution, its agents
or servants.
_________________________________ _____________________
Student
Signature
Date