ATU - Secondary Education Field Experience Placement Spring 2023
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First Name *
Last Name *
Student T# *
Tech e-mail *
Where do you live during the school week? *
Example:  Tech Campus - Russellville, Ozark, Lamar, etc.
What is your major field?   *
Check one 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 at, and their position.
Example:  Father - Atkins School District - Atkins High School - Principal
Do you have children attending an Arkansas public school? *
If yes, provide their relationship to your, their grade level, and the name of the school, and the school district.
Example:  Daughter - 6th Grade - Kraus Middle School/Clarksville
Do you have any siblings (or nieces/nephews) that attend an Arkansas Public School? *
If yes, provided their relationship to you, their grade level, the school district, and the school name.
Example: Sister - 11th Grade - Dardanelle School District - Dardanelle High School
What year did you graduate high school? *
Where did you attend and graduate high school? *
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