Fillable STUDENT INFORMATION AND INTEREST INVENTORY (You will not (Northeast Wisconsin Technical College)

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STUDENT INFORMATION AND INTEREST INVENTORY (You will not (Northeast Wisconsin Technical College)

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STUDENT INFORMATION AND INTEREST INVENTORY
(You will not be placed in a practicum experience until this form is completed)
Name
Address
Home Phone Work/Cell Phone ______
Currently Enrolled in the IAAD Program: Yes or No Anticipated Graduation Date_______
Completed Medical Form: ________ (YES) _________ (NO)
Completed Background Check: ________ (YES) _________ (NO) Please submit/show a copy of card
(Required to be updated yearly)
Local school districts may also require you to complete their own criminal background check.
Current Practicum Interests:
If you are planning to go for your bachelor’s degree please let me know as well. Your next career path will
influence your practicum placements.
Interests
1
st
choice
2
nd
choice
School Name:
Classroom Type Grade/Age/General
Ed/Special Ed
Principal Name
Principal Email and Phone
Teacher Name(s)
Teacher Email and Phone
Are you currently employed at this
school?
Do you have children at this school?
What do you hope to gain from this course and practicum experience?
REMINDER: The technical college instructor will contact/arrange for your Practicum
Placement unless other arrangements have been discussed with NWTC instructor.
Students will not be placed in the classroom of immediate family members and may
not be placed at the same school.
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STUDENT INFORMATION AND INTEREST INVENTORY (You will not (Northeast Wisconsin Technical College)

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Completed 10 October 2020

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