ATU - Middle Level Field Experience Placement Fall 2019
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Last Name *
First Name *
Student T# *
Tech e-mail *
Where do you live during the school week? *
Example:  Tech Campus - Russellville, Lamar, Ozark, etc.
Check the areas of your major. *
Check two of the following.
Required
Are you currently employed by a public school? *
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? *
If yes, provide their relationship to your, their district, the school they work in, and their position.
Example:  Father - Atkins School District - Atkins High School - Principal
Do you have children attending an Arkansas public school? *
If so, provide their relationship to you, the school district they attend, the school they are at, and their grade level.
Example:  Daughter - Clarksville School District - Kraus Middle School - 6th Grade
Do you have any siblings (or nieces/nephews) attending an Arkansas Public School? *
If so, provide their relationship to you, the school district they attend, the school they are at, and their grade level.
Example: Sister - Dardanelle School District - Dardanelle Middle School - 7th Grade
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