Fillable SCHOOL OF EDUCATION OUT OF AREA STUDENT TEACHING (Peru State College)

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SCHOOL OF EDUCATION OUT OF AREA STUDENT TEACHING (Peru State College)

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SCHOOL OF EDUCATION
OUT OF AREA
STUDENT TEACHING PLACEMENT REQUEST
An out-of-area student teaching placement is a placement that is outside of Nebraska and is 100 miles or more
from the Peru campus in Iowa, Missouri or Kansas. If you choose to student teach outside of the PSC service
area you will have additional responsibilities.
This form is an Adobe PDF document. Click on the text boxes to type in your information or reveal drop
down boxes. Fill out the form and then print. You will not be able to save the completed form, so you may want
to save an extra copy for your files.
Arrange to speak with the Director of Field Experiences/Certification Officer, Ms. Stephanie Holmes, by
emailing her at SHolmes@peru.edu. Your appointment will need to be at least 10 days prior to the date
your student teaching application is due.
Date you contacted Ms. Holmes for an appointment:
Date you met with or spoke with Ms. Holmes regarding your placement:
Ms. Holmes will email you with a confirmation of your discussion, please print the email and attach it to this
form.
Once you have met with Ms. Holmes and have discussed your placement, you may start making
arrangements for your placement.
1. You will need to obtain the contact information for the school or district you wish to apply to student teach
within. (You may check the school website and contact the school for this information.)
Contact information of the person who arranges placement of student teachers.
Full Name and Title
School Address
City, State Zip
Phone
Fax
Email
2. What is the deadline for submitting your student teaching application to the school?
Are there any additional requirements for submitting a student teaching application?
Continue to page 2.
3. Find out if the Cooperating Teachers are paid for hosting a student teacher.
(So
me states require this)
If so, what is the amount?
Please understand that you will have to bear the burden of this cost. Nebraska does not allow cooperating
teachers to be paid, and therefore Peru State College cannot pay this for you. You will be required to submit a
check for this amount to your cooperating teacher, and prior to starting your student teaching assignment.
4. You will need to obtain the information for a college supervisor. Check with a field experiences director of
any teacher education college or university in the area of the school you are applying or with your contact at the
school district. Obtain the contact information of this person.
College Supervisor Name
Address
City, State Zip
Phone
Fax
Email
5. Find out the charges for a college supervisor.
Please understand that Peru State College will pay up to $835 for a 16-week placement plus mileage. You are
responsible for any charges over that amount. These charges must be paid before the student teaching grade is
posted.
THIS COMPLETED FORM IS DUE WITH YOUR APPLICATION FOR STUDENT TEACHING.
I have compiled the requested information. I understand there may be additional payments and
responsibilities involved with my out-of-area student teaching and I agree to make those payments as
requested.
____________________________________________
Student Signature
____________________________________________
Date
I have reviewed the attached information.
____________________________________________
Advisor Signature
____________________________________________
Date
This application has been reviewed and accepted by the Director of Field Experiences.
____________________________________________
Director of Field Experiences Signature
____________________________________________
Date
Yes
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SCHOOL OF EDUCATION OUT OF AREA STUDENT TEACHING (Peru State College)

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Completed 25 August 2020

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