| STUDENT TEACHING INFORMATION SHEET |
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| Semester/Year |
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| Teacher
Candidate's Name |
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Current Phone Number |
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| Current
Address |
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E-mail |
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| City,
State, Zip Code |
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College Supervisor |
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Cell Phone
Number |
Emergency
Phone Number |
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| Quarter
1 Placement |
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| School
District |
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School Name |
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| School
Address |
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City, State, Zip Code |
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| School-Based
Teacher Educator's Name |
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School Phone Number |
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| School-Based Teacher Educator's E-mail |
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| Quarter
2 Placement |
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| School
District |
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School Name |
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| School
Address |
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City, State, Zip Code |
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| School-Based
Teacher Educator's Name |
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School Phone Number |
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| School-Based Teacher Educator's E-mail |
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| Coaching
Assignment |
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| Sport
and Level |
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| School
District |
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School Name |
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| School
Address |
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City, State, Zip Code |
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| Supervising
Coach Name |
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School Phone Number |
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| Supervising Coach's E-mail |
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| Submit
the following hard copies to Janet Peluso-Militello; Coordinator of Field
Experience, PE & HE; The College at |
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| Brockport; 350 New Campus Drive; Brockport, NY 14420; or fax to (585) 395-5055 by Friday, September 10, 2010: |
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| 1.
TWO TOTAL COPIES of the completed Student Teaching Information Sheet.(OK if Q2 unvailable forward at a later date) |
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| (www.brockport.edu/pes/undergrad/teached/index.html) |
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| 2.
Your teaching schedules (OK if Q2 unavailable -- forward at later date).. |
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| 3.Directions from Brockport/supervisor base to your student teaching assignments |
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| 4. Copy of annual school district calendar sheet (one-page list of days off, conference days, etc). |
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| *PLEASE BE SURE TO INCLUDE YOUR NAME ON ALL ITEMS
SUBMITTED. |
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| **DO
NOT CONTACT THE PLACEMENT OFFICE TO CONFIRM RECEIPT OF YOUR MATERIALS. |
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| ***YOU WILL BE CONTACTED IF THE REQUESTED MATERIALS HAVE
NOT BEEN RECEIVED. |
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