STUDENT TEACHING INFORMATION SHEET
Semester/Year
Teacher Candidate's Name						Current Phone Number
Current Address						E-mail
City, State, Zip Code						College Supervisor
		Cell Phone Number			Emergency Phone Number
Quarter 1 Placement
School District						School Name
School Address						City, State, Zip Code
School-Based Teacher Educator's Name						School Phone Number
School-Based Teacher Educator's E-mail
Quarter 2 Placement
School District						School Name
School Address						City, State, Zip Code
School-Based Teacher Educator's Name						School Phone Number
School-Based Teacher Educator's E-mail
Coaching Assignment
Sport and Level
School District						School Name
School Address						City, State, Zip Code
Supervising Coach Name						School Phone Number
Supervising Coach's E-mail
Submit the following hard copies to Janet Peluso-Militello; Coordinator of Field Experience, PE & HE; SUNY Brockport;
Dept. of PE & Sport; 350 New Campus Drive; Brockport, NY 14420; or fax to (585) 395-5005 by Friday, February 1st:
1. FOUR TOTAL COPIES of the completed Student Teaching Information Sheet.
(www.brockport.edu/pes/undergrad/teached/index.html)
2. Your teaching schedules.
3. Directions from Brockport/supervisor base to your student teaching assignments.
4. Copy of annual school district calendar sheet (one-page list of days off, conference days, etc).
*PLEASE BE SURE TO INCLUDE YOUR NAME ON ALL ITEMS SUBMITTED.
**DO NOT CONTACT THE PLACEMENT OFFICE TO CONFIRM RECEIPT OF YOUR MATERIALS.
***YOU WILL BE CONTACTED IF THE REQUESTED MATERIALS HAVE NOT BEEN RECEIVED.