SurveyMonkey Powered Online Survey

Cooperating Teacher Confirmation Contract

Please provide all the information requested below and submit.

Question Title

* General Information

First Name:

Last Name

Address:

City/Town:

State:

ZIP:

Email Address:

Social Security Number* or MSU ID Number :

*Morehead State University must have cooperating teacher social security numbers for submission to the Education Professional Standards Board (EPSB) for a stipend to be processed. If you are not comfortable submitting your social security number through this online format, you may call 606-783-9353 and speak to Kim Terry OR print, complete, and mail this form to Teacher Education Services (address below).
Morehead State University
801 Ginger Hall
Morehead, KY 40351

Question Title

* Please select the degree completed:

5th year

15 or more hours toward Rank II

Rank II

Rank I

Other (please specify)

Question Title

* Number of years of teaching experience:

Question Title

* Please select school district:

Other (please specify)

Question Title

* General Information

Question Title

* Please select the degree completed:

Question Title

* Number of years of teaching experience:

Question Title

* Please select school district:

Question Title

* Please enter school name: