Teaching Practicum Data Form and Agreement

This form will be used to help the Teacher

Education Department identify an appropriate
collaborating school and cooperating teacher.

1. Name: Leanza Marlanie Dawson

2. Home Address: Arnold Avenue Burrell Boom Village

3. Phone Numbers: 620-8915

4. Email Address: leanzamarlenie22@gmail.com

5. If you are on study leave, please state from which management and from which school.

6. If you are currently working in a school, please state which management and which
school.

7. Please list all primary schools:

(a) That you have previously worked in.

None

(b) That a family member works in. Please state the position held by the family
member and the relationship to you.

None

(c) That a child of whom you are the parent or guardian currently attends.
• All saints Primary School
• St. Martins De Porres Preschool

(d) That you attended as a child.

 St Ignatius Primary School
I hereby confirm that all the information above is accurate and that I have
provided all relevant information. I also confirm that I have read and
understood the course outline for Teaching Practicum I and that I agree to
abide by all elements of it.

Signed Date
L. Dawson 05-05-21