MAIN CAMPUS - Application for Admission to Student Teaching

This application is for Main Campus (Winfield) students only.

If you are enrolled in the Professional Studies program, please go to the Professional Studies Student Teaching Application.

Biographical Information

Last Name*  
First Name*  
Date of Birth*  
Campus/Local Address*  
E-mail Address*  
Phone Number*  
No. of Children (optional)  
Marital Status (optional)  
Faculty Advisor*  
Teaching Major*  

Record of College Attendance (include Southwestern)

First Institution:

Dates (inclusive)

Name of Institution


Second Institution:

Dates (inclusive)

Name of Institution


Third Institution:

Dates (inclusive)

Name of Institution



College extracurricular experiences (include type of activity, year and your position):

Memberships in organizations (civic, honor, social, service, etc.):

Travel experience:

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):

Additional Information

List responsibilities you will be carrying in addition to student teaching (other college courses, outside work, home responsibilities, extracurricular activities):

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?*
Yes No


List four (4) references - one personal and three college professors. Students or family recommendations are not accepted.

First Reference:


Address (including zip code)*

Second Reference:


Address (including zip code)*

Third Reference:


Address (including zip code)*

Fourth Reference:


Address (including zip code)*



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,
3. insubordination,
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.

I further understand that, in the event of disapproval of this application, or of deferment, or of subsequent removal from the teacher education program following acceptance I am entitled to certain rights as set forth herein."

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 or her.

7. The committee shall render a fair and impartial decision based upon the evidence.

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.

In the event that the student has been advised that he or she has been removed from an off-campus assignment, the following procedure will be followed:
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 document.