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* 1. First/Last Name

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* 2. Student Cell Phone Number

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* 3. Student Preferred Email

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* 4. Major/Certification

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* 5. Have you completed the following:

  yes no
I have completed an August 2019 - May 2020 background check (see link at latechcrrc.org)
I have joined A+PEL to hold liability insurance for the 2019-2020 academic year.
I have submitted evidence of background receipt and APEL receipt to my professors.

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* 6. Check every course you are currently taking that includes a field experience.

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* 7. Rank (top 3) your preference of district placement for your field experiences this fall quarter so we can finalize placements.

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* 8. Click every grade you have already experienced observing/teaching:

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* 9. List any relatives that you may have in a district (faculty, staff, district office, etc.)

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* 10. Please note any special accommodations needed, comments, etc.

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