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College of Education – Undergraduate Studies

Application Form for Student Teaching


PT-Form 1

A. Profile
Name: ____________________________ ______________________________ __________________________
SURNAME GIVEN NAME MIDDLE NAME
Course: _________________________________ Major: __________________________ Age: ____________
Contact Number: _______________________ Name of Guardian: ___________________________________
Address: __________________________________ Contact Number of Guardian: ______________________
Remarks by the PT Supervisor

Remaining Subjects to enroll on


____Semester, A.Y.____________

No. of Units to enroll on


_____ Semester, A.Y.__________
Subjects with Deficiencies REMARK
(INC, FAILED) (NP/RI/LR/FAILED/NGS)

B. Pre-Screening
C. Final Screening
Requirements Status Date Completed
1. Academic Records/Evaluation Forms
2. Written Exam Prof. Ed. Score: _________
Gen. Ed Score: __________
3. Interview
4. Demo Teaching
5. Other Requirements to be accomplished
- TOR (for Transferees only)
- F137
- Birth Certificate (PSA)
- Marriage Certificate (for Married only)
- Parent’s Consent
- Approval Sheet (Thesis)
- Thesis Number
- Medical Exam
Overall Result: __________________________________ Evaluated by: _______________________________

ACAD-TED-FM-068 Rev 0 Effective 15 Nov 2021

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