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CES Potential Seminary Teachers

Preservice Center Student Teacher Information

Name Mission Degree major ID number Age Type of degree and graduation date

Picture (color)

G BA G BS Date _______________________
Degree major Type of degree and graduation date

G MA G MS Date _______________________
Degree major Type of degree and graduation date

G EdD G PhD G Other Date ____________________

Work experience since earning bachelors degree (be specific)

Marriage information

Engagement or marriage date

G Single G Engaged G Married

Home city (where you grew up) Number of children Home

G Rent G Own

Spouse Information
Name (include maiden name) Spouse mission Home city (where spouse grew up)

Center Ranking
If not hired now, would you recommend another student teaching year? G Yes Center ranking* Preservice Trainer placement suggestions

Central Office Notes

G No

G Urban G Rural G Anywhere

Comments about Student Teacher Note: Faculty not listed below who observe teacher, should make their comments on reverse side.
Manager (M. Vellinga)

Trainer 1 ____________ Trainer 2 ____________ Principal ____________ Date Area Director ___________ Seminary Period SOAS Class

Field Consultant ____________ Other ____________ Number of student teaching years Number of early-morning years Total number of years

* Where does teacher rank in Preservice Center prioritization in relation to knowledge, performance, attitude, character, skill, and in relating to students (this is not to be a biographical sketch) 11/2006 Printed in the USA 00225CES