aker Teacher Preparation Program ‘olla: Student Teaching Application AvplcationDesline:Spibg Stet Testing = ly QGI Ly _ Zz ‘Campus: AP. ez Oca oct, pr. ask om Sow um: Name: vnom JOH 143 igo QMale fe Preferred E-Mal: nies: [f. Sidet a oe od tiie nt 1699 Inmadiately not your colege supervise of any changes toe Infrmstion proved atv ‘At ceresponclones wil be sent fo the mag eddress i the Bakr Callog database, Portfolio, ‘You must submit an accoptable copy of your portfolio with this application, Please reference the Portfolio Guide for necessary documents, ‘additional Requirements Background Check: Your compus must have yate Cerfiad Background Chook and offical Michigan Doparimont of Human Sorvicas Giearance Report (fraquired) on fl. If your background check indicates any convcticn or recorded ‘vent in your background, your campus must confirm that you have successfully appealed to remsin in the program, Program Completion Plan: You must suscessfully complet two Theory and Techniques courses prio to student ‘teaching, You must have 9 or fewer credits cemining In yaur program al tha fina your begin student teaching. You and your campus DiractoriCaordinator of Education will mutually agree upon a schedule for your remaining coursewerk and program completion. Deviations from that schedule may delay your placement for student tasching, graduation, and ‘crifcation. You are raqurad to ablain approval from your home campus DirectoriCoordinator of Education for courses taken at another Baker College campus Peman aan pressure way vin ve LDL Bachelor's Degree Program’) Posthaccalaurente Certificate Program eee ata, Minor(s) iol norety, ete) for your placement: Secondly Baie ‘Gonaidtoe: Indicate three bjt area preferences algobra, tr smant: 4st Choice: ana ctice: 8 sudthoicn List three preferences forthe dstict and school of your placement Contact yaur Teacher Preparation Progtamn fice for a Istof cists in which your campus can place student teachers, List three choidés forte grade tevel of your pl 7 Suet TancNeg ArpNote: Placemante eannat be mado in nulls whore you atfondod schocl, oF in buldings where fami members curently work ar atnd School Candidate preferences wil te accommodated wher posse assigning placemenis. Hawaver, a numberof at fects mast aso bo consider, inluaing the scheduing ard reasonable aroun of Fave! expected af taker Collogo susorsing teaches end the avaiabliy Cf suitable pncoments,Plosee natty Gaker Colage af any epackl accemmoalions you wil rogue whe cudnt teaching. Dist seteok JHy i Di LOE OD serest 00, vias OWOSSO es Do} Inde ye aoa ert aie ond coopers tid bos: a eas Conviction Disclosure ‘You MUST answar te folowing questions, Attach additonal shuts as necessary 4. Hove you ever baen carveted of any felony or misdemeanor? DYes Xe Hyes, provide the folowing information for each conviction: Specie cme: Date of conviction: _ Court, city, and state: Full description of creumstances: fom corte ecg tno? ove Ae yes, flly daseribe ta circumstances: Certification Statement oar that al ifr agree to abide by al policies and requvamnanis Gn tis application and nthe Teacher Preparation Program —— Handbook. understand that Lam tesparsible ‘or meeting all colege and programa requirements in eft at tho Ke tine of admission. | understand tht, if reoncol at Baker Colege after « break of ane setester or longer ion provided on this application is accurate and compat. (exctucing summar semeste), must completo the requirements in effect atthe time of resnroliment tundrstand that the State of Michigan periadicaly revises is teach cariication rules, and that | must meet all requirements in effec at the tine of certfcaion. Tundartand that rust abide By the ees and Sandards accepted by eiucaton protssionals. This waudes issues relted to appropriate cress, personal conduc, professional attude, and confidentiaty of candidate information, Tunderstand thal my campus musthave my background check resUIG on fle, Inclodig @ fagarpnt check or Carte Background Check and for candidates taking ona or more eay chichood education (ECE) courses a Michigan Department of Human Services Cental Rogstty Cloarance. f my background check indicates any conviction, pending court action, or recorded ever, must have completed a successful appeal to remain in the program. | confirm dat | wl nmactately eportin wring any conviction, pending coutt action, or other recorded fevent that has not yet been reported or that subsequently cocars to my carnpus Director Coordinator of Education. understand that eddtfonal background checks may be required, and that | wil be responsitie forall costs ‘associated wit my background checks, s the passe exception of ganeral education courses. Initial Each Bax te Show Your Understanding of Each Statement Ke | Trundersiand that I must eam a C or balor in dach course Used toward graduation and teacher corifican, wit | Tundersiand that its my responsiblity ib contact ny campus DredorCcordnaior of Education Ihave any osrer7 sugeerteching Are‘Guasionsvogaring rogram 6 ludntaaching daiason, relorUon, roan, or camplaon T permit all rlovant nfomalion to bo eased to school david porsonnal and the Stale of Michigan, for he purpose of securing field placements, student teaching placements, and ray teaching carticate IK Signature: | ‘Agptcaton packets must be aonroved by both campus and eystenn Teacher Prepsraton Program sa Refer othe ouent Teacher Preparation Program Nondook or cartes yoor carpus Dresor/Coordator ef eaucston for mea vermaon on program pales and proeodures 7 euaenTescing top