MAIN CAMPUS - Student Teaching Placement Request

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 Placement Request.

Biographical Information

Last Name*  
First Name*  
E-mail Address*  
Phone Number*  
Assignment Preference - Semester*       
Assignment Preference - Year*       

List Class Assignment Preference

College personnel will consider all requests and preferences, but total responsibility for placement rests with Southwestern College supervisors and school administrators.

Under no circumstances are students to make direct contact (phone, email, letter, in person) with potential cooperating schools, administrators, or teachers.

First Preference:


Secondary/Elementary: (indicate subject or grade)


School Location Preference

Second Preference:


Secondary/Elementary: (indicate subject or grade)


School Location Preference

Third Preference:


Secondary/Elementary: (indicate subject or grade)


School Location Preference

Signature

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.

Signature

Date