SUTEC Student Application for New York City Student Teaching and Fieldwork/Observation
THE STATE UNIVERSITY OF NEW YORK - URBAN TEACHER EDUCATION CENTER (SUTEC)

Directions: Students requesting student teaching assignments in New York City must complete this form. Please return the application package to your campus Director of Student Teaching.

If you have any questions regarding student teaching in a New York City school please contact the SUTEC office by emailing Natalie.Lukas@suny.edu or Regina.Anderson@suny.edu.
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1. Last Name: *
2. First Name: *
3. Date of Birth *
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4. College / University: *
5. Expected Graduation: *
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/
DD
/
YYYY
6. Contact Phone: *
enter in the format ###-###-####
7. E-mail: *
8. Preferred Method of Contact: *
9. Student Teaching or Fieldwork/Observation *
Required
10. Placement Level: *
Required
11. Certification Area: *
12. Student Teaching or Fieldwork/Observation Term:
Term: *
Year: *
13. Permanent Address:
Street: *
City: *
State: *
Zip Code: *
Phone: *
enter in the format ###-###-####
14. Where do you plan to reside while student teaching in New York City?
Street: *
City: *
State: *
Zip Code: *
Phone: *
enter in the format ###-###-####
15. Preference for a placement site, please mark at least two of the following boroughs: *
Required
16. The Director of Student Teaching on your campus is:
Director's Name: *
Phone: *
E-mail: *
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