ATU - Elementary Education Field Experience Placement Fall 2019

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Please complete the following form in full in order to receive your placement(s) for the fall semester.

First Name *

Last Name *

Student T# *

One Tech e-mail *

Where do you currently live during the school week? *

Example: Tech Campus - Russellville, Ozark, Harrison, etc.

Are you currently employed by a public school? *

Yes

If yes, provide the position and the school district/city.

Example: Teacher's Aide - Two Rivers School District/Ola

Do you have relatives employed by a public school in Arkansas? *

Yes

If yes, provide their relationship to you, the district they work in, the school they work at, and their position.

Example: Father - Atkins School District - Atkins High School - Principal

Do you have children attending an Arkansas public school? *

Yes

If yes, please list their relationship to you, the name of the district, the name of the school, and their grade level.

Example: Daughter - Rogers High School - 11th Grade

Do you have any siblings attending an Arkansas public school?

Yes

Clear selection

If yes, please list their relationship to you, the name of the district, the school they attend, and their grade level.

Clear form

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