Intent to Student Teach

If you leave this application prior to submission, your progress will not be saved. Please review the necessary components in preparation to beginning the application to ensure you have all necessary documentation. 

Assignment Type (Check all that apply)*

Personal Information

Please notify the Whittier College Teacher Education Program if any of your contact information changes (including email) before or during your student teaching assignment. You will miss important notices if we are not notified.

Name*
Date of birth*
Mailing Address*
Permanent Address (if different from above)
Are you bilingual?*
Are you biliterate?*

Health Requirements

Districts may have additional processes for prospective student teachers. Whittier College will not provide the district with results of a TB test or Certificate of Clearance. It is the student’s responsibility to provide the district with this information if needed.


If you have ever been arrested or convicted of a felony, please discuss this with the Chair of the Department of Education before registering. Except in unusual circumstances, a credential will not be issued to persons who have felony convictions.

I have provided the Credential Analyst with the results of a recent TB test. I understand that these results will be verified before my application to student teach can be fully processed. (DO NOT include this document with your application). *
I have provided the Credential Analyst with a Certificate of Clearance, 30-day Substitute Permit and/or Intern Credential. I understand that these results will be verified before my application to student teach can be fully processed. *
I have provided the Credential Analyst with a copy of a valid CPR card.*
I understand that I must provide a valid CPR card to the Credential Analyst in order to be Intern eligible.*
I understand that I must provide valid CPR card to the Credential Analyst in order to apply for a preliminary credential. *

Educational Background

Date of Graduation*
I understand that I must have earned at least a B- in all credential courses and pre-requisites. *
I understand that I must maintain a B average in all credential coursework.*
I have completed required coursework considered prerequisites for student teaching*
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I have completed the Child Development course requirement by completing*
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I have completed the US Constitution requirement*
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I understand that I must complete both the Child Development and US Constitution requirements to be Intern eligible.*
I understand that the Child Development course and US Constitution requirements must be met prior to applying for a preliminary credential. *
I have completed fieldwork observations in the following credential courses (check all that apply) *
If you have completed fieldwork for a course that is not listed (e.g., 300/500, 406/506) you can upload the log alongside one for another course.
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I understand that an audit of my fieldwork hours will be conducted. Based on this audit, my student teaching experience may be extended in order to meet the required 600 hours of Clinical Practice.*
I have completed the Basic Skills Requirement by passing the CBEST or with an approved alternative.*
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I have completed an approved Subject Matter Program*
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I have passed all required sections of CSETs associated with my credential (individuals who have completed an approved Subject Matter Waiver Program should mark "no"). *
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Working as a Substitute Teacher

Have you applied to be a substitute teacher?*

Student Teaching Placement Preference

Indicate your preferences for a student teaching assignment. Not all requests can be accommodated. Some districts are considered “out of our area”

Acknowledgement of Risk and Ability to Participate

Working with children/youth may expose you to illness, diseases, and other health risks, which you might not encounter in situations where children/youth are not present. Conversely, under certain circumstances, such as chronic illness or recent exposure to contagious disease, your presence might increase risks to children/youth and staff members.

To protect your wellbeing to the greatest extent possible, as well as that of children/youth and staff, all students enrolled in courses involving student teaching must complete this Acknowledgement of Risk and Statement of Ability to Participate.

I have read the information above. I am aware of and voluntarily accept potential risks inherent in working with children/youth in a school setting. I further acknowledge that I will participate only when I am in good health and free from exposure to communicable disease.*
Health statment

Final Review and Acknowledgements

I understand that I will need to enroll in the appropriate section of EDUC 420/520 (student teaching) and EDUC 421/521 (student teaching seminar). These courses may have associated lab fees.*
I understand that if I am pursuing a Multiple Subject or Single Subject credential, I will be required to complete the CalTPA Instructional Cycle during my student teaching*
I understand there are program policies regarding whether any student can complete student teaching concurrently with the MA course sequence (EDUC 605 & EDUC 606)*
I have reviewed all the information provided in this application. To the best of my knowledge, all this information is true and I have not made any misleading or incorrect statements. I understand that if information is missing and/or incorrect, the processing of my application may be delayed. *

Linda Brennan Review and Approval

Is the Application Complete?*

Rosa Rosas Review and Approval

Does the candidate have a valid clearance document (sub permit, CoC, etc.)?
Does the candidate TB clearance valid throughout student teaching placement?
Has candidate completed required testing (CBEST, CSET)?
Will candidate meet coursework requirement to be eligible to student teach?

Director of Clinical Practice Review and Approval

Decision*