This application is for Professional Studies students only.
If you are enrolled in the Main Campus (Winfield) program, please go to the
Main Campus Student Teaching Application.
Name of Institution
College extracurricular experiences (include type of activity, year and
Memberships in organizations (civic, honor, social, service, etc.):
Military Service (include branch of service and when):
Name of high school where you graduated:
Town where your high school is located:
High school extracurricular experiences:
Experience background (list experiences with children and/or groups
including type of activity, location, dates and your position):
Other work experience (include work, location, dates and your position):
List responsibilities you will be carrying in addition to student
teaching (other college courses, outside work, home responsibilities,
Describe physical concerns which may influence teaching responsibilities:
Have you ever been convicted of a felony or crime involving dishonesty, a
controlled substance, or a child?*
List four (4) references - one personal and three college professors.
Students or family recommendations are not accepted.
Address (including zip code)*
AGREEMENT BY APPLICANTS AND PARTICIPANTS IN THE CENTER FOR TEACHER
EDUCATION AT SOUTHWESTERN COLLEGE, WINFIELD, KANSAS
The Center for Teacher Education of Southwestern College, Winfield, Kansas,
recognizes the importance of careful selection of persons admitted to, and
retained in the department's program. The department also recognizes the
importance of proper removal from the program of students who violate the
program's standards, and that students have the right of due process.
The application for admission to the teacher education program form shall
include the following statement:
"Having requested admission to a program that requires certain high
standards of character and professional competence, and that includes
off-campus assignments in public school classrooms, I understand that my
admission to the teacher education program may be deferred, disapproved, or
that, if I am accepted, I may be removed subsequently from the program for
the following cause(s):
1. immoral character,
2. conduct unbecoming a teacher in training,
4. failure to obey reasonable rules promulgated by the college and/or
cooperating school district,
5. failure to show normal improvement and evidence of professional training.
Students may access the due process procedure through either the Education
Department Director or the chair of the Hearing Panel of the Teacher Education
Committee (named annually).
The procedure for due process for a student who has his or her application
rejected or deferred is as follows:
1. The student is notified in writing of the date, time, and place of a hearing
before the education committee of Southwestern
College. Said hearing shall take place not later than ten (10) days following
the mailing of the notice of the hearing.
2. The student has the right to have counsel of his or her own choosing present
at the hearing and the right to receive the advice of such counsel or such other
person(s) as may be selected.
3. The student may have parents or guardians present at the hearing.
4. A summary of testimony of witnesses, if any, shall be read at the hearing. If
requested in advance, the witnesses may testify in person at the hearing.
5. The student shall have the right to present witnesses in his or her behalf
who may testify either in person or by affidavit.
6. The student shall have the right to testify in his or her own behalf and
shall have the right to cross-examine any witnesses who will testify against him
7. The committee shall render a fair and impartial decision based upon the
8. The student shall be informed in writing of the decision of the Education
Committee within ten (10) days of the hearing and of his or her status in the
teacher education program.
1. If the cooperating school initiates action for removal from an off-campus
assignment, the supervising teacher will notify the principal who will contact
the college coordinator and furnish him or her with statements regarding the
nature of the difficulty and signed by the supervising teacher and principal.
2. All the rights of the student as set forth above in the procedure for due
process shall apply.
By typing my name in the Signature textbox below and submitting this
online form I certify under penalty of perjury that all information provided is correct and complete. I understand that my application
is not valid if I have knowingly falsified information. I hereby certify by
my signature that I have read and understand all of the provisions of this
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