Students Teacher Placement Form

Receiving University: Universitas Islam Darul Ulum Lamongan (UNISDA)

Instruction:

 This form should fill-in by receiving university and send back to sending university and cc SEAMEO Secretariat (seateacher@seameo.org).
 Please indicate your own university name above by using abbreviation.
 Below is the list of student teacher from sending university that accepted by receiving university.
 The receiving university should indicate students’ teacher name from sending university to be placed at host school according to the availability of the grade(level to teach) and subject to
teach based on the agreement between receiving university and host school.

Major/Field Year of
Name of Student Gender Subject to
No. of Study at Study Topic to Teach* Level to Teach* Host School
Teacher Accepted (M/F) Teach*
University (3 or 4 )
rd th

1. Baby Von B. Bajenting M English 3rd Year English Integrated language skills Upper SMK NU 1
Secondary Karanggeneng
School (USS) Lamongan
2. Jeremy Q. Zulueta M English 3rd Year English Integrated language skills Upper MA Matholi’ul Anwar
Secondary Karanggeneng
School (USS) Lamongan

*Level to teach *Subject to teach *Topic to teach

- Lower Secondary School (LSS) - English - Economic Education Please mention specific topics in
- Upper Secondary School (USS) - Math - Primary/Elementary the subject that students’ teacher
- Pre-School - Science - Social Science have to teach in the classroom
- Primary/Elementary - Pre-School - Physical Education

SEAMES Eff 19062019_B8